Response: Re: The Impact of Prior Authorization Requirements on Primary Care Physicians’ Offices: Report of Two Parallel Network Studies

To the Editor:

In the letter regarding our study of prior authorization costs,¹ Schneider² describes a “seemingly dramatically improved efficiency compared with earlier studies.” This is an incorrect reading of our results. We do not believe that our report describes an improvement in efficiency over earlier estimates. Rather, it estimates costs using an entirely different method than previous studies and comes up with different results. It is our feeling that the studies we cited—by Casalino et al,³ Morra et al,⁴ and Sakowski et al⁵—represent the high end of a range of possible estimates and that our studies represent the low end. True costs are probably somewhere in the middle and are certainly dependent on the context, as Schneider points out.

Regarding processes that may have affected cost outcomes, we currently are analyzing the existing data set using inferential statistical techniques. There are early suggestions that practice characteristics (particularly the use of electronic health records) might play a role. However, the exact mechanisms and relationships between processes and costs are by no means certain. We hope to describe results from our secondary analyses in a future report. Regardless of what we find, a much larger study than ours would be required to answer definitively questions about the effects of particular processes on prior authorization costs.