Somebody chose this
Prior authorization feels like weather — something that happens to a clinic rather than something a clinic can influence. It is not. Every requirement list, every fax number, every turnaround window is a decision made by a person inside a payer, and decisions can be renegotiated.
That reframing matters because it changes who in your organization owns the problem. Treated as weather, it belongs to whoever is least senior. Treated as a design choice, it belongs to contracting, informatics, and clinical leadership together.
Measure before you complain
The most effective practices count three things: how many requests they file per clinician per week, how many are approved without modification, and how many hours of staff time each approval consumes. Those numbers convert a chorus of frustration into a negotiating position.
A payer that learns ninety-four percent of your requests for a given drug are ultimately approved is being told, in its own language, that the review is producing delay rather than stewardship. Gold-carding conversations start there.
What to fix this quarter
Standardize the five most common requests into templates with the clinical criteria pre-populated. Assign one person as the escalation owner rather than rotating it. Track denials by reason code, not by volume — the reason code tells you whether the problem is documentation, formulary, or eligibility.
None of this abolishes prior authorization. It reduces the share of it that lands on the person wearing the stethoscope.
Key takeaways
- Count requests, approval rate, and staff hours before opening a payer conversation.
- Denials by reason code tell you which fix actually applies.
- One named escalation owner beats a rotating duty every time.
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How to cite
Vejayan PD. Prior Authorization Is a Design Choice, Not a Law of Nature. On The Beat MD. Published July 29, 2026. Available at: https://www.onthebeatmd.com/insights/prior-authorization-is-a-design-choice
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This material is educational and is not medical, legal, or financial advice. It does not create a physician-patient or attorney-client relationship.
© 2026 Priya D. Vejayan. All Rights Reserved. Except as permitted by applicable copyright law, reproduction, distribution, or commercial use of original content requires written permission.