How Long Do Prior Authorizations Take in Specialty Pharma?

How Long Do Prior Authorizations Take in Specialty Pharma?

For patients prescribed specialty medications, every day waiting for a prior authorization (PA) is a delay in critical treatment. In the specialty pharma space, where therapies often target serious or complex conditions, the prior authorization process plays an even more pivotal role.  

At careviso, we understand how essential it is to reduce time to therapy. Knowing what to expect and where delays tend to occur can help HUBs, manufacturers, and providers create a more efficient path to access for patients.

The Reality: How Long Does It Really Take?

Timelines for specialty prior authorizations vary depending on payor, therapy class, and the level of documentation required:

• Initial PA Review:
  For most specialty medications, prior authorization decisions take between 7–10 business days, even under standard review timelines. For newer therapies or less common indications, this can extend longer due to payor review processes and clinical validation.

• Urgent Requests:
  When designated as urgent (often for rapidly progressing or life-threatening conditions) some PAs can be reviewed within 24–72 hours, but that’s highly dependent on payor policy and documentation.

• Appeals or Additional Documentation:
  If an initial PA is denied or pended, appeals can add 5–15 additional business days, particularly if the case involves external medical review or peer-to-peer consultation.

• Out-of-Network Challenges:
  For providers or therapies outside of the payor’s preferred network, the process may involve exception requests, which can significantly extend timelines.
  
  READ MORE: What is a Prior-Authorization?

Why Specialty Takes Longer

Specialty drugs are high-cost, high-touch therapies with complex administration, distribution, and monitoring requirements. Because of these factors, the PA process is more detailed—often requiring:

• Extensive clinical documentation and chart notes

• Proof of previous therapies or step edits

• Lab results or genetic testing

These steps require coordination between providers, payors, specialty pharmacies, and HUB services—many of which still rely on faxes, phone calls, and manual follow-ups.

The Cost of Waiting

Delays in specialty PA don’t just impact time-to-therapy—they lead to increased abandonment, decreased adherence, and worsening patient outcomes. Research published in Managed Healthcare Executive indicates that while prior authorization requirements apply to about 7% of all prescription claims, more than a third of those prescriptions (37%) are ultimately not filled.

READ MORE: careviso Releases Comprehensive 2024 Audit Uncovering Ongoing Administrative Burden of Prior Authorizations in Diagnostic Testing

How careviso Helps

Our solution, seeQer, can identify if a prior authorization is required for each patient case. Our platform enables:

• Real-time visibility into payor requirements and status

• Automated documentation workflows tailored to specialty cases

• Faster turnaround through payor integrations and smart routing

• Reduced administrative burden for HUBs and providers

The result? A more transparent and efficient process that shortens the path from prescription to therapy.

In specialty pharmaceuticals, prior authorization plays a critical role in how quickly patients can start essential therapies. careviso is committed to supporting this process by providing the transparency and efficiency needed to reduce delays and improve access to care.

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