The Real Cost of Prior Authorization Fatigue

Prior authorization was intended to manage costs and ensure appropriate care, but for many patients in Colorado Springs, it can delay needed treatment. At Asthma & Allergy Associates, PC, we regularly see delays involving inhalers, biologics, and allergy therapies. This article explains prior authorization fatigue, how it can affect your health and costs, and what you can do.

Estimated reading time: 5 minutes

What Is Prior Authorization Fatigue?

Prior authorization requires providers to obtain health plan approval before certain medications, tests, or treatments are covered. For specialties involving biologics, immunotherapy, and newer treatments, repeated or delayed approvals can frustrate patients and providers alike.

Daniel F. Soteres, M.D., M.P.H., coined the term Prior Authorization Fatigue Syndrome (PAFS) to describe the cumulative strain caused by repeated and prolonged authorization barriers. He later discussed how PAFS impedes asthma care on KevinMD.

Early Signs to Watch For

Repeated denials, resubmissions, and appeals do more than slow care. They chip away at confidence in the system and can push people to give up on treatments they genuinely need. An unfilled prescription or a repeatedly delayed follow-up can signal a bigger issue. Spotting them early helps our team step in before a small delay becomes a serious gap in care.

How Does Prior Authorization Affect Colorado Springs Patients?

Our patients often tell us how exhausting the waiting can be.  Someone with poorly managed asthma may need a specific inhaler or biologic today, not three weeks from now, yet an approval can stall treatment during that critical window. When delays stretch on, some people skip or abandon therapy altogether, which is dangerous for chronic conditions that depend on consistency.

Local Factors That Complicate Approvals

A delayed treatment can turn a manageable condition into a flare that sends someone to urgent care. That’s exactly what our team works to prevent. A 2024 American Medical Association survey found that 82 percent of physicians reported prior authorization sometimes causes patients to abandon recommended treatment, and we see the human weight of that number in our own exam rooms.

Resource: ama-assn.org

Pressure on Independent Practices

The administrative workload associated with prior authorization can contribute to burnout among the very people patients rely on. Smaller independent practices feel it sharply, since they lack the large administrative departments that bigger health systems dedicate to processing requests. In a community like ours, where access to specialty allergy and immunology care matters, this pressure may contribute to provider shortages and lengthen appointment wait times.

How Do Delays in Care Actually Happen?

When we prescribe a treatment that requires approval, the request goes to your health plan, which reviews it against its coverage rules and formulary. Delays often start here, when the insurer asks for more documentation, questions the medical necessity, or requires that you try a lower-cost option first, a practice known as step therapy. You can appeal a denied request, but each round adds days or weeks.

Why Specialty Treatments Face More Hurdles

Specialty therapies draw more scrutiny than routine ones, which is why biologics, immunotherapy, and advanced allergy and immunology treatments so often get caught in review. Outdated systems make everything slower. Many requests still rely on faxes and cumbersome insurer portals rather than efficient electronic processes, and current reform efforts aim to fix that inefficiency.

How Are Local Healthcare Systems Responding?

Across Colorado Springs, providers and health systems are working to reduce the burden wherever they can. Many local clinics now use electronic tools that speed up submissions and cut reliance on faxes and phone calls. Close coordination between primary care providers and specialists like us also helps, since sharing complete records early prevents the back-and-forth that causes delays. We point patients toward community resources and patient-assistance programs when coverage gaps appear.

What Solutions and Advocacy Efforts Exist?

Progress is underway at both the state and federal level. Colorado has passed reforms to streamline prior authorization and improve transparency. Federally, the Improving Older People’s Timely Access to Care Act would require Medicare Advantage plans to standardize electronic approvals, report approval and denial data, and meet faster deadlines for urgent requests.

Groups Backing Reform

A broad coalition supports this legislation, including the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology, which represent our specialty. Some insurers have reduced prior approval requirements, while patient advocacy groups provide education and support. We encourage you to ask your providers and insurers what approvals are required and how long they may take.

Resource: aaaai.org

What Can Patients Do to Protect Themselves?

You hold more influence in this process than you might expect. Start by staying organized. Keep a record of every prescription, request, and phone call, along with dates and the names of anyone you speak with. Ask us and your insurer what documentation is needed upfront, since complete information often prevents delays.

Know Your Rights and Speak Up

You can appeal a denied request, and our team is ready to help you build that appeal with the clinical evidence it needs. Get familiar with your rights under Colorado insurance rules, which set standards for how quickly insurers must respond. When a delay puts your health at risk, escalate the request or ask us to flag it as urgent. Most importantly, keep us informed.

Resource: fixpriorauth.org

We Are Here to Help

Prior authorization fatigue is a growing burden for our Colorado Springs community, but you don’t have to face it alone. Our team at Asthma & Allergy Associates, PC works every day to move approvals forward so you can get the asthma, allergy, and immunology care you need without needless delay. Contact our office to schedule an appointment.