Treatment Abandonment Due to Prior Auth Delays: The Hidden Cost Nobody Tracks

There's a data problem at the center of the prior authorization conversation.

Everyone tracks denials. Plans track appeal rates. Practices track turnaround times. What almost nobody systematically tracks is the patient who simply stops — who walks away from a prescribed treatment because the approval process outlasted their patience, their energy, or their practical ability to keep following up.

That patient disappears from the data. Their outcome — disease progression, an emergency visit six months later, a treatment that was never tried — doesn't get coded as a PA-related event. It gets coded as nothing. The system moves on without acknowledging what happened.

What Treatment Abandonment Actually Means in This Context

Treatment abandonment in the PA context is distinct from a denial. A denial is an insurer saying no. Abandonment is a patient (or sometimes a provider) deciding to stop pursuing approval — even though the clinical case was sound, the drug was appropriate, and the original prescription still stands.

The AMA's 2024 survey data put the number at 78% of physicians reporting that PA caused patients to abandon recommended care. A separate analysis found that roughly 29% to 33% of patients who encounter a PA barrier ultimately do not get the prescribed treatment — not because it was denied, but because they stopped trying.

That's approximately 1 in 3 patients.

For biologics — which often represent the most appropriate, most carefully chosen therapy for a patient with serious inflammatory disease, cancer, or a rare condition — that statistic is not abstract. It means a rheumatologist who prescribed the right drug for a patient with active RA watched that patient give up on it. The disease kept progressing. The drug was never tried.

Why Patients Give Up

The reasons aren't complicated, but they matter.

The process is genuinely exhausting. A standard biologic PA can involve multiple rounds of documentation, phone calls to the insurer, calls from the insurer to the office, a denial, an appeal process, a peer-to-peer review request, and weeks of waiting at each stage. For a patient already managing a chronic illness — already fatigued, already stressed — this is a significant burden. Many patients don't have the bandwidth to sustain it.

Worsening symptoms force a different decision. When a patient's condition deteriorates significantly during the PA wait, their physician sometimes has to pivot to a different intervention — a course of steroids, a hospitalization, a different drug that's on formulary without PA. The original biologic gets abandoned by circumstance, not by explicit decision. That pivot never gets recorded as a PA-driven outcome.

Insurance changes break the chain. A patient who changes employers, ages into Medicare, or loses coverage during an extended PA process often has to restart the approval process entirely under new coverage. For many patients, that reset is the breaking point. Commonwealth Fund research found insurance transitions to be a major contributor to treatment abandonment in specialty drug access scenarios.

The office loses track. High-volume specialty practices handle dozens of PA requests simultaneously. When a request stalls — waiting for additional documentation, waiting for an appeal decision, waiting for a peer-to-peer to be scheduled — it can fall through the cracks. The patient stops hearing from the office. The office assumes the patient will call if they have questions. Nobody calls. The prescription lapses.

The Cost to Your Practice

Treatment abandonment isn't only a clinical problem. It's a financial and operational one.

Every PA that results in abandonment represents clinical time spent on documentation, phone calls, and appeals that generated no revenue. A dermatologist whose staff spends four hours pursuing a biologic PA for a psoriasis patient — only to have the patient abandon the treatment because the process took five weeks — absorbed that cost entirely.

The estimated annual cost of PA administrative burden to the US healthcare system exceeds $35 billion. That figure captures time, staff hours, and infrastructure — but it doesn't capture the lost revenue from prescriptions that never got filled because the patient gave up. For specialty practices where biologics are a significant part of the revenue mix, that's not a theoretical exposure.

There's also a liability dimension that rarely gets discussed openly. When a patient abandons appropriate treatment due to PA delays and subsequently suffers a preventable adverse event — a hospitalizable Crohn's flare, a joint deformity from uncontrolled RA, disease progression in an oncology patient — the documentation trail matters. A practice that can demonstrate it pursued the PA diligently, communicated with the patient throughout, and documented every step is in a fundamentally different position than one that cannot.

The Cost to Patients

A patient who abandons a biologic for moderate-to-severe Crohn's disease doesn't stop having Crohn's disease. They just stop having the treatment.

What follows is predictable: disease continues progressing on inadequate therapy, fistulas form, inflammation spreads, surgical intervention becomes more likely. Crohn's & Colitis Foundation data shows that patients who experience delays in biologic initiation have significantly higher rates of subsequent surgery and hospitalization — events that are both worse for the patient and more expensive for the system than the biologic that was supposed to prevent them.

For oncology patients, the stakes are higher still. Treatment abandonment or delayed initiation in certain cancers is not a quality-of-life issue. It's a survival issue.

How to Reduce Abandonment in Your Practice

Some of this is systemic — it requires regulatory change, payer reform, and legislative action that providers alone can't drive. But there are practice-level levers that make a measurable difference.

Track every open PA like a patient chart. The practices with the lowest abandonment rates treat pending PA requests as active clinical items, not administrative tasks. Someone owns each request. Someone checks its status. Someone notifies the patient when there's an update or when action is needed.

Communicate proactively with patients about timelines. Patients who understand that a biologic PA often takes 2 to 4 weeks — and who receive regular updates — are less likely to assume silence means abandonment. The ones who disappear are usually the ones who never knew what to expect.

Submit right the first time. The fastest path through the approval process is a complete, payer-specific submission on the first attempt. Every denial adds 2 to 4 weeks to the timeline, and each week added increases the probability the patient gives up. Tools that generate complete documentation in under 2 minutes — like those at Luma — make same-day submission achievable, which compresses the overall timeline significantly.

Build appeals capacity into your workflow. A first denial isn't the end. Most denials for appropriate biologic use are overturned on appeal or peer-to-peer. The problem is that many practices don't have the staff bandwidth to pursue appeals consistently. Making appeal pursuit a systematic process — not an ad hoc one — keeps more patients in the treatment pathway.

The Measurement Gap Needs to Close

Here's my honest take: the industry will not fix what it doesn't measure. As long as treatment abandonment lives outside the standard metrics that payers, practices, and regulators track, it will remain invisible — and the patients who disappear from care will continue to be invisible with it.

Some forward-thinking health systems have started building PA abandonment tracking into their quality dashboards. That's exactly right. When the data exists, accountability follows.

Until then, every practice can make a choice about how rigorously it pursues approval — and how diligently it keeps patients in the loop while it does.

Sources:
American Medical Association. (2024). 2024 AMA Prior Authorization Physician Survey. ama-assn.org
Commonwealth Fund. (2023). Prior Authorization Barriers: Patients' Views. commonwealthfund.org
Cutler, D.M., et al. (2022). The Administrative Cost of Prior Authorization. Health Affairs. healthaffairs.org
Crohn's & Colitis Foundation. (2019). The Impact of Inflammatory Bowel Disease in the United States. crohnscolitisfoundation.org
Dusetzina, S.B., et al. (2023). Prior Authorization and Specialty Drug Access. Health Affairs. healthaffairs.org