Most common treatments subject to prior authorization

Genetic testing, specialty drugs and high-tech imaging are some of the most common treatments that require prior authorization, according to a Nov. 14 survey from AHIP.

The health insurance trade group conducted an industrywide survey on prior authorization practices and gold carding experiences of commercial plans between February and April. AHIP received responses from 26 plans covering 122 million commercial enrollees.

The most common treatments subject to PA:

  • Genetic testing: 100 percent

  • Specialty drugs: 100 percent

  • Elective inpatient surgical services: 92 percent

  • Election inpatient medical services: 88 percent

  • High cost non-specialty prescription drugs: 88 percent

  • High-tech imaging: 88 percent

  • Post acute care facility services: 88 percent

  • Cardiology: 80 percent

  • Durable medical equipment: 80 percent

  • Orthopedics: 80 percent


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