In June 2025 many healthcare insurance companies promised to reduce the burden of requirements for prior authorization for treatments. Prior authorization delays treatment, increases uncertainty, and burdens patients and healthcare providers with substantial costs in time and effort to fill out paperwork. As of May 2026, surveys of doctors, administrators, and patients still found prior authorization requirements to be a burden, many not detecting a noticeable change.
This is consistent with what Dr. Ben Goldacre has observed about big pharma firms. When patients or policy makers complain about some practices, such as lack of transparency in reporting clinical trials that fail to support a new drug, the firms promise to take action, and policy makers move on to other issues, thinking that the complaint has been resolved. But often the firms do not deliver on their promises, which amount to “fake fixes” (Goldacre 2013, pp. 47, 54, 299, 333, and 343). Letting our guard down based on the “false reassurance” (Goldacre 2013, pp. 47 and 54) of their promises, no one holds them responsible.
What is true of big pharma firms may also be true of healthcare insurance firms.
The problem is not that the firms are led by evil people, but that perverse incentives lead good people to do bad things. The perverse incentives are an unintended consequence of a baroque system built largely with good intentions.
For the article documenting the continuing burden of prior authorization rules, see:
(Note: the online version of the article has the same date as the print version, and has the title “Medical Care Delays for Approval Persist, Despite Insurers’ Promises.”)
Goldacre’s book, that I praise above, is:
Goldacre, Ben. 2013. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. New York: Farrar, Straus and Giroux.