Health Care Prior Authorization Practices

Prior authorization—sometimes referred to as preauthorization or precertification—is a process by which an insurer reviews a request for health care services or drugs before consenting to cover the costs of the proposed treatment. Upon receiving a request, an insurer can approve or deny the request, or request additional information from the patient or their health care provider. Health insurers may require prior authorization for a variety of reasons, including cost control and verification of medical necessity. This issue brief provides an overview of the prior authorization practices used by health insurers, including private health insurance carriers and public insurers such as Medicaid.