Independent practices completed an average of 40 prior authorization requests per physician every week in late 2025, according to the American Medical Association's annual survey of 1,000 practicing physicians. Forty percent of those practices now have a staff member who works on prior authorization exclusively, a role that did not show up as a distinct line item in most practice budgets a decade ago.
The AMA fielded the 44-question survey in December 2025 through a Medscape physician panel, split 40.0% primary care and 60.0% specialists, and published the results on May 13, 2026. Respondents were screened to confirm each one practiced in the United States, saw patients at least 20 hours a week, and completed prior authorizations during a typical week of practice. The picture it draws is less about whether prior authorization is a burden and more about how far that burden now reaches into practice staffing and appeals workflow, with wide variation from payer to payer.
How Much Time Prior Authorization Now Takes
Physicians and their staff spend a combined 13 hours a week on prior authorization tasks, the AMA survey found. That workload has not leveled off: 74.0% of physicians said the number of prior authorization requests required for their patients increased over the past five years, against 21.0% who said the volume held steady. Only 3.0% reported a decrease.
The 40.0% figure for dedicated prior-authorization staff is a practice-structure detail as much as a workload one. Rather than spreading the work across front-desk and clinical staff, four in ten practices in the survey have moved it into a standalone role as volume keeps rising.
What Happens After a Request Goes In
Submitting a request does not mean a fast or clean answer. Nearly one in three physicians, 32.0%, said requests are often or always denied outright. Growth in required prior authorizations was uneven by category: 84.0% of physicians who handle prescription-drug prior authorizations said that volume rose over five years, and 82.0% of those handling medical-service requests said the same.
Practices also lose time simply figuring out whether a request is needed at all. 63.0% of physicians said it is difficult to determine whether a prescription medication requires prior authorization, and 62.0% said the same about a medical service. Practice technology has not closed that gap: 27.0% said the prior-authorization information in their EHR or e-prescribing system is rarely or never accurate, and only 24.0% said their EHR supports electronic submission of prescription prior authorizations. Phone remains the most commonly used method for completing them, the AMA reported.
Appeals, and Why Many Practices Skip Them
Only 21.0% of physicians said they always appeal an adverse prior-authorization decision. Among those who do not, 59.0% said they did not believe the appeal would succeed based on past experience, 52.0% cited insufficient practice staff time, and 49.0% said the patient's care could not wait for the health plan to rule on an appeal.
Letting a denial stand has its own downstream cost. 88.0% of physicians said the prior-authorization process leads to higher overall use of health care resources for their patients, most commonly through additional office visits, cited by 73.0%, followed by urgent or emergency care at 47.0% and hospitalization at 32.0%. Each of those outcomes adds scheduling and billing work on top of the original request, work that falls back on the same practice staff.
How the Burden Compares by Health Plan
The AMA survey asked physicians to rate the prior-authorization burden as high or extremely high for six national health plans. UnitedHealthcare drew the highest rating, at 75.0%, and Blue Cross Blue Shield the lowest of the six, at 56.0%.
| Health plan | Rated high or extremely high burden | Physicians rating (n) |
|---|---|---|
| UnitedHealthcare | 75.0% | 861 |
| Humana | 65.0% | 756 |
| Anthem/Elevance | 61.0% | 726 |
| Aetna | 61.0% | 827 |
| Cigna | 59.0% | 797 |
| Blue Cross Blue Shield | 56.0% | 857 |
Source: American Medical Association, 2025 AMA Prior Authorization Physician Survey, published May 13, 2026. Physicians who did not work with a given plan were excluded from that plan's count.
Burden also varies by line of business rather than plan alone. Medicare Advantage drew the highest rating among four categories, at 69.0% (n=746), ahead of commercial or private-payer plans at 63.0% (n=930), Medicaid at 62.0% (n=815), and traditional Medicare fee-for-service at 47.0% (n=740).
Whether the 2025 Insurer Pledge Changed Anything
In June 2025, more than 60 health insurers pledged to voluntarily reform their prior-authorization programs, with commitments staggered from mid-2025 through January 2027. Only 33.0% of physicians surveyed by the AMA said they thought the pledge would make a meaningful difference for patients and physicians. A separate KFF poll fielded around the same time found consumers about as doubtful: 39.0% believed insurers would follow through.
The one pledge commitment already in effect at the time of the survey was ensuring that denials based on medical necessity get reviewed by a licensed, qualified clinician. Just 24.0% of physicians said that was happening, and among physicians who take part in peer-to-peer reviews, only 16.0% said the health plan's reviewer often or always had appropriate qualifications for the case. On gold-card programs, which exempt high-performing providers from routine prior authorization, only 5.0% of physicians reported having a contract that included one. Looking ahead, 60.0% of physicians said they were concerned that increased use of artificial intelligence by health plans would raise prior-authorization denial rates further.
Sources
- American Medical Association, "2025 AMA Prior Authorization Physician Survey," May 13, 2026
- American Medical Association, "AMA survey: Prior authorization reform pledge falls short with physicians," May 13, 2026
- KFF, "KFF Health Tracking Poll: Public Finds Prior Authorization Process Difficult to Manage," 2025
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