Prior Authorization is Failing Patients Like Me

By John Czwartacki

Imagine doing everything right. You make appointments to see your specialist. You follow your treatment plan. You take the daily medication to treat your symptoms. And then, without warning, your insurance company decides you need their permission to stay healthy.

This is reality for me, and millions of other Americans.

Living with multiple sclerosis (MS) means managing symptoms that shift and evolve over time. Years ago, my neurologist prescribed a treatment that dramatically improved my severe fatigue from my condition. It allowed me to keep working, remain an active father and husband, and to communicate clearly when my disease’s progression began affecting my speech. My treatment greatly improved my energy and ability to complete my daily responsibilities.

This worked well for me until one day I was suddenly subjected to prior authorization.

Every refill launched the same frustrating cycle. The pharmacy would inform me that my prescription was “pending approval,” meaning my doctor would have to justify my treatment yet again.

Often times, days would pass before I got my medication. I had to resort to cutting my pills in half, or going full days without any medicine. While every disease comes with its own symptoms, MS made these days particularly hard because it became harder to speak or have the energy to be myself.

My story is just one of millions. Far too many Americans face barriers like prior authorization that, when used where they aren’t needed, block them from access to treatments. Once marketed as a safeguard against unnecessary spending, prior authorization has now morphed into a systemic barrier between patients and care that is often used in unnecessary situations. It allows payers to serve as gatekeepers, inserting themselves into decisions that should belong to the physicians and patients.

For patients with chronic illnesses, autoimmune disorders, cancer, or progressive neurological diseases, delays can mean irreversible harm — not just frustration. Many medications require daily usage and insurance companies use prior authorization as a blunt instrument that slows access regardless of urgency.

When patients are forced to navigate repeated denials, paperwork, and appeal, some will give up. I resorted to, in effect, self-medicating with expensive over-the-counter energy shots and caffeine drinks because someone thought they could pocket a few dollars if I didn’t push to fill a prescribed generic medication.

No one argues that healthcare spending should go unchecked. But when cost containment consistently overrides clinical judgement, the system is not functioning properly.

Patients fighting serious illness already carry enough weight. By allowing prior authorization — or other systems like step therapy requirements — to disrupt medication cycles and bog physicians down with paperwork, the healthcare system prevents access with an unnecessary barrier to helping Americans live normal lives.

Our thriving innovation pipeline has delivered medical breakthroughs that patients 30 years ago would not be able to imagine. The least our healthcare system should do is ensure needless barriers don’t prevent patients from accessing these treatments.