Waiting for a prescription medication, treatment, test, or medical procedure can mean the difference between relief and suffering, progress and setback. As a caregiver and a patient, I know this firsthand. And too often, these delays don’t come from a shortage of options or a slow provider, but from red tape, because an insurance provider has added an extra step in the process.

This delay is usually thanks to a process known as prior authorization. What used to be a tool for managing cost and evaluating the need for novel or high-risk treatments has now ballooned into an obstacle course. It’s increasingly applied to generic medications, routine imaging, and even long-standing treatment regimens.

In 2023 alone, Medicare Advantage insurers made nearly 50 million prior authorization determinations—and denied 3.2 million of them. Physicians are just as fed up. According to the American Medical Association, 93% of doctors say prior authorization leads to care delays, and more than 1 in 4 say it has directly resulted in a serious adverse event for a patient.

As someone who has had to navigate this process from every angle—patient, caregiver, advocate—I’ve seen its harm play out time and time again.

For over 15 years, my mother has lived with Parkinson’s disease, and while I’m a long-distance caregiver, I still help to coordinate roadblocks with appointments, in challenging billing errors, and following up when things fall through the cracks. I also help care for my 95-year-old grandmother, who still lives independently and does everything in her power to maintain her autonomy—but sometimes needs someone to push when the system won’t budge.

Most recently, I’ve been forced into the fight for my own care. I’ve lived with psoriasis for years—a condition that can be painful, scarring, and mentally taxing—and was successfully treated with a biologic medication for over five years. But that treatment is now out of reach. Why? Because of how I switched health plans.

I stayed with the same insurance company. I kept the same policy level. But I moved from a public exchange individual plan to my employer’s group coverage—and the same payer, who had previously approved my treatment, now refuses to cover it. I’ve relied on a “covered until you’re covered” program to access the medication, but as of this month, I’ve hit the lifetime limit on that support. I’m being forced off the only treatment that has worked—because of bureaucracy.

This is what caregivers and patients are up against.

Prior authorization becomes a much more dangerous barrier when pain treatment is involved. After surgery, injury, or a flare-up of a chronic condition, pain management isn’t optional—it’s urgent. The first 72 hours after surgery are often the most critical window, but the prior authorization process can drag out for days or even weeks. That delay can mean unnecessary suffering, slower recovery, and worsening outcomes.

So, how do we cope in a system like this? Here are a few hard-earned tips I’ve picked up from both personal experience and through the work we do every day at Caregiver Action Network, where we connect caregivers to real-time support, policy advocacy, and free resources on FAM-Network.org:

1. Stay organized

Keep all documentation—appointment notes, prescriptions, emails with providers, call logs with insurers—in one place. The burden shouldn’t be on you, but having everything ready can make the process slightly less grueling.

2. Understand your insurance

Know what your plan actually covers. Every insurer has its own rules around timelines and what’s considered “medically necessary.” It’s confusing—but knowledge is power.

3. Work with your provider

Make sure your doctor is looped in and providing detailed medical justification when submitting a prior authorization request. Incomplete or vague forms are an easy excuse for insurers to deny.

4. Know your rights

Many states require insurers to respond to prior authorization requests within a specific time—especially for urgent care. Use that to your advantage.

5. Push back

If you get denied, don’t stop there. Appeal. Ask for the reason. Provide more documentation. Many denials are reversed—but only if someone fights back.

6. Explore assistance programs

If you’re stuck, check for manufacturer copay or patient assistance programs. They can offer short-term relief while you fight for long-term access.

At Caregiver Action Network, we believe no patient should be denied care because of paperwork. No caregiver should have to shoulder the emotional and administrative burden of navigating a broken system just to ensure their loved one—or themselves—can access what a doctor has already prescribed.

It’s time for real reform of prior authorization. Until then, we’ll keep fighting—because caregivers and patients deserve better.