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Prior authorization requirements have become a defining feature of modern clinical practice, shaping not only treatment decisions but also the day-to-day workflow of clinicians. For nurse practitioners (NPs) and physician assistants (PAs), who increasingly serve on the front lines of patient care, the administrative burden associated with securing insurance approvals for medications, imaging, and specialty referrals can be substantial.

As healthcare systems rely more heavily on advanced practice clinicians to expand access and manage complex patients, many report that prior authorization demands are consuming significant clinical time, delaying care, and contributing to workforce strain — in some cases even pushing clinicians out of practice.

A Growing Administrative Load

In many settings, NPs and PAs are deeply embedded in the prior authorization process — from initiating requests and submitting documentation to conducting peer-to-peer reviews and managing denials. These responsibilities often extend beyond their own patient panels.

“Prior authorization was an everyday occurrence in my practice,” said Jamie Threatt, DNP, AGACNP-BC, telehealth program director at LocumTenens.com. Threatt has a lengthy background in both inpatient and outpatient settings prior to her current role. “I managed all authorizations and appeals for medications, imaging, and procedures not only for my own patients but for four physicians in our practice as well.”

The time burden can be substantial.

“On a busy day, insurance-related administrative work, including forms, peer-to-peer reviews, and appeals, could easily consume 2-3 hours,” Threatt said. “That time does not disappear; it gets borrowed from somewhere else, usually from patient care or from the end of an already long day.”

Clinicians across practice settings describe similar experiences.

“Most NPs and PAs deal with prior auths every single day,” said Nathan Byrnes, MSN, APRN, head of medical at NEXT|HEALTH in Nashville, Tennessee. Byrnes worked in a family practice setting before joining NEXT|HEALTH. “And it’s not quick. You’re filling out forms, tracking down labs, writing extra notes, and sometimes it just leads to getting on long calls just to explain why your patient needs something.”

Those hours come at a cost.

“Those are hours that can be better used on things that truly matter…patient care,” Byrnes said.

Delays in Care and Treatment Disruptions

Prior authorization requirements can also directly delay care, particularly for high-cost therapies and diagnostic services.

“My specialty is severe asthma, so I frequently seek authorization for injectable biologic medications,” Threatt said. “These therapies can be genuinely life-changing for the right patient. These approvals can take days, and when appeals are involved, sometimes weeks. Those delays have real clinical consequences.”

Threatt said these delays are far from “just administrative.”

“When a patient can’t access their biologic in a timely way, their disease can spiral, leading to increased exacerbations, courses of systemic steroids, and in some cases, emergency department visits or hospitalizations,” she said.

Byrnes described similar barriers across a range of services.

“We see it with everything — medications, imaging, even labs,” he said. “You might have a patient who clearly benefits from a certain medication, no question. But insurance still says, ‘Not yet.’”

Step therapy requirements and coverage thresholds can further complicate care.

“They want the patient to fail other meds first or hit certain numbers before they’ll even think about approving it,” Byrnes said. “Meanwhile, you’re trying to be proactive and give your patient access to what is best for their health.”

Imaging requests can be similarly delayed.

“You know your patient needs an MRI or ultrasound. But you still have to jump through hoops,” he said. “Try this first. Wait. Try something else. Wait again. It’s like being stuck in traffic when you can already see the destination.”

“These delays in healthcare aren’t small,” Byrnes said. “They matter. They can change outcomes.”

Impact on Clinician Workload and Burnout

The administrative demands of prior authorization are increasingly recognized as a contributor to clinician burnout — particularly for NPs and PAs managing high patient volumes.

“On many days, prior authorization processes consumed multiple hours of my clinical day,” Threatt said. “The downstream effects compound quickly: patient appointments get pushed, clinic days run long, and documentation often gets completed after hours.”

Beyond time, the emotional toll can be significant.

“What is harder to quantify, but just as real, is the mental weight of it,” she said. “As a licensed clinician, I am forced to spend my afternoon on hold with an insurance company instead of in the exam room.”

“A big part of the day turns into fighting denials,” Byrnes said. “It’s frustrating. It slows you down; it burns people out. No one went into medicine thinking, ‘I can’t wait to argue with insurance companies all day.’”

For some clinicians, the cumulative burden is reshaping career decisions.

“The administrative burden of medicine was a contributing factor in my own decision to leave direct clinical practice,” Threatt said. “The profession is losing experienced clinicians, not to retirement or burnout in the traditional sense but to a system that has made the act of caring for patients increasingly difficult to sustain.”

Byrnes has made a similar shift.

“Honestly, that’s a big reason I stepped away from the traditional model,” he said. “I just wanted to practice medicine the way it should be — focused on the patient, not playing by broken system rules.”

Practice-Level Strategies to Reduce Burden

In response, practices are experimenting with strategies to manage prior authorization demands, though clinicians describe these as incremental improvements rather than solutions.

“We developed several approaches that helped, but none of them made the problem go away — they just redistributed the burden,” Threatt said.

Some practices assign dedicated staff to handle authorizations, though this can be cost-prohibitive.

“Having a team for prior auths helps,” Byrnes said. “But that is an extra expense to clinics, and not all clinics have the ability to take on that cost.”

Other approaches include carving out administrative time, using electronic submission portals, and standardizing documentation.

“We used online submission portals whenever possible, though many payors still require faxed forms and supporting documentation,” Threatt said.

Clinicians also rely on work-arounds such as prepopulating forms and partnering with specialty pharmacies to handle portions of the process.

“Every one of these work-arounds required time, coordination, and compromise that should not be necessary in the first place,” she said.

Byrnes said that even with these efforts, the burden remains.

“Better systems help. Clear checklists help. But even with all that, it’s still a grind,” he said.

Patient Experience and Shifting Care Models

As delays and administrative friction persist, clinicians say patients are increasingly aware of — and frustrated by — the impact.

“Patients are starting to take notice,” Byrnes said. “They feel the delays and friction.”

He said that in some cases, that frustration is influencing care choices.

“That’s why more people are going to cash-pay clinics,” he said. “It’s quicker, simpler, and they can actually get answers without waiting weeks for approval.”

For those who can pay, cash-pay clinics may represent a shortcut worth taking, akin to other time-saving “upgrades.”

“Time is everything, and cash-pay clinics are the equivalent to paying for the fast pass at amusement parks where they get to skip the line,” he said. “And if it’s this frustrating for us, I can’t imagine how it feels for the patient sitting there, waiting.”

Calls for Policy Reform

At the policy level, clinicians are calling for reforms that reduce administrative burden while preserving appropriate cost controls.

“I understand the need to manage costs. Maintaining a formulary of preferred medications is reasonable,” Threatt said. “But there should be a meaningful mechanism for a clinician’s judgment to override an algorithm.”

She emphasized that care decisions should ultimately rest with the clinical team. “The care a patient receives should be driven by their clinical team — those who know their history, their comorbidities, and most importantly, their prior treatment failures.”

Byrnes also said that more responsive systems are needed.

“If something is proven to work, it shouldn’t take weeks to approve,” he said. “If we already know the right treatment, patients shouldn’t have to fail first.”

Balancing Cost Control and Clinical Care

While prior authorization is intended to manage healthcare costs and ensure appropriate utilization, its implementation continues to create friction at the point of care.

For NPs, navigating coverage barriers has become a routine, and often burdensome, part of practice. As their role in delivering care continues to expand, addressing the administrative challenges associated with prior authorization may be critical not only for workflow efficiency but also for sustaining the clinical workforce and ensuring timely patient care.

Byrnes and Threatt reported having no disclosures.