Automation can take cost out of prior authorization. Whether it takes cost out of your program depends on what happens after the first rejection.
Prior authorization is one of the most expensive administrative steps in U.S. healthcare, and electronic prior authorization is the obvious fix. Moving requests off fax and phone cuts staff time, speeds up payer decisions, and costs a fraction of a manual submission. According to the 2025 CAQH Index, the industry still has a $21 billion savings opportunity in administrative transactions that haven't been fully automated.
So, the short answer is yes. The longer answer depends on where you measure. Savings per transaction are easy to count. Savings for patients who actually start therapy are harder to earn, and for specialty and rare disease programs, that's the number that matters.
The true cost of a prior authorization
The administrative burden of a prior authorization is real, and it's well documented. Physicians complete an average of 40 prior authorizations per week, consuming about 13 hours of physician and staff time, according to the 2025 AMA Prior Authorization Physician Survey. Two in five physicians employ staff dedicated exclusively to prior authorization. Meanwhile, only 40% of medical prior authorizations were conducted fully electronically in the 2025 CAQH Index, up from 31% in the 2023 Index.
That's the cost most automation pitches are built around. But it's not where most of the cost ends up.
A 2026 JAMA Health Forum study of 2024 IQVIA pharmacy claims looked at branded prescriptions that hit a prior authorization rejection. Only 35% were processed within a day. The rest took a median of six days, and a quarter took 12 days or longer. Just 54% were eventually approved.
The downstream effects are where the costs add up. In the same AMA survey, 79% of physicians say patients abandon treatment because of authorization challenges, and 26% report that prior authorization has led to a serious adverse event. 88% say it increases overall healthcare utilization, citing ineffective first treatments, additional office visits, urgent or emergency care, and hospitalizations.
So essentially, if a request is submitted in seconds but takes 12 days to resolve, we haven’t really saved anything. The delay has just moved to a different stage of the process.
For manufacturers, that delay carries its own costs: lost patient starts, free drug dispensed through bridge and quick-start programs while a decision is pending, and staff hours spent chasing status. However, none of it appears on the prior authorization line item.
Where automation does bend the cost curve
Automating prior authorization isn't the mistake. Treating automation as the whole answer is. Used in the right places, it takes real cost out of a program:
Knowing a prior authorization is required before the prescription stalls. A benefit verification that flags PA requirements, formulary status and step therapy up front prevents the most avoidable rejection there is: the one nobody saw coming.
Complete first submissions. Pre-populating patient, diagnosis and prior therapy data, and matching it to payer-specific documentation requirements, cuts missing-field rejections before they happen.
Electronic submission and status. Moving requests off fax and phone, and replacing the call-and-check loop with real-time case status, frees staff for the cases that actually need them.
Routing and deadlines. Flagging cases stuck in pended status, or approaching a reauthorization date, before they become a missed window.
For these steps, automation should move the case forward without delay. When it does, costs fall in two places at once: fewer staff hours per case, and fewer days between prescription and first fill.
Automation lowers the cost of prior authorization when it's pointed at the right problem. For specialty programs, that problem isn't how fast a request goes out. It's how quickly a patient gets to first fill.
Want to see where prior authorization is costing your program the most? Talk to the Elusa Health team.
Sources referenced
Administrative savings opportunity ($21 billion): 2025 CAQH Index announcement, CAQH, February 2026.Electronic prior authorization adoption (31% to 40%): CAQH Index Finds $20 Billion in Cost Savings Opportunities, AJMC, May 2026.Physician burden, abandonment, adverse events, utilization and denial trends (40 PAs per week, 13 hours, 79%, 26%, 88%, 74%): 2025 AMA Prior Authorization Physician Survey, American Medical Association, May 2026.Branded prescription PA delays and approval rates (35% within a day, median six days, 54% approved): Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation, JAMA Health Forum, 2026.
