GLP-1’S REQUIRE PRIOR AUTHORIZATIONS
If you don’t know what a prior authorization is, you’re a lucky person. However, if you do, you know they can be a real pain. The concept of a prior authorization makes perfect sense because it’s designed to save the insurer money. When a physician orders a complicated, expensive procedure, such as an MRI, the insurance company wants proof from the ordering physician that the patient has met the criteria required for authorizing that test. There is a series of questions posed to the doctor challenging him to verify the patient has the problem suspected and needs to have the test to done. If all criteria are fulfilled, the insurance company will authorize doing the test and paying for it.
Because GLP-1’s are so popular and so expensive, they fall into the category requiring a prior authorization (PA). GLP-1’s can be prescribed by any physician, but most often it becomes the responsibility of the family doctor who sees the patient often and knows him/her best. PA’s take time to complete. The busy FP will be asked to do 15-20, or more a week, so if a PA takes 10-30 minutes to complete, or if the doctor himself has to talk to the reviewer, it can be long a drawn out process. The reviewer has a set of questions specific to the diagnosis and reasons for which the drug is being prescribed, and the doctor’s representative has to have the information necessary to show the patient needs the drug. Of course, that isn’t always easy to do.
PA’s can delay care. If a second review is needed, that draws out the time required for authorization. GLP-1’s are complex, and each insurer has his own “form” and different qualifying criteria, so there’s no single, straightforward answer to get approval. That makes obtaining authorization that much more difficult. The work load for physician’s offices becomes overwhelming, and it’s all work for which you receive no compensation. Most offices have a paid staff member whose sole job it is to obtain prior authorizations.
Most of the time, tests are authorized and drugs are approved, but when they aren’t, a back up plan is a good idea. The family doctor is doing this for his patient and paying a person in his office to perform the service, all out of the sense of responsibility to his patient. When you consider all the services provided by the family physician free of charge, the physician begins to look at his practice as a “medical mission field.” The compensation he receives for most things he does is ridiculously low and insulting to his profession. Prior authorizations are just more of the same — uncompensated services. Previously, Medicare did not require prior authorizations for drugs or procedures. But now, in 2026, AZ will be one of the 6 states required by Medicare to do PA’s in a study to test the waters. That’s just another of the many situations making private practice less attractive to physicians.
Reference: Peck J. The Hidden Toll of GLP-1’s Care Complexity on PCP’s Medscape 2025 October 29.
