Prior Authorization 

Many patients seeking medication vital to their arthritis treatment are held up by prior authorization, a process in which a physician must submit tedious paper work before writing a prescription. Find out what can be done to simplify this process. 

The Issue

  • Typically, physicians must fill out a prior authorization form whenever they prescribe a specialty medication or treatment that is restricted or not covered under an insurance carrier’s formulary. 
  • Each insurance provider (insurer) uses its own unique form, and physicians may have to spend many hours familiarizing themselves with, and completing, dozens of forms of varying lengths and complexities. 
  • As a result, prior authorization typically causes lengthy delays in treatment, thereby restricting a person's access to vital care. 

The Solution

The Arthritis Foundation worked with the American Medical Association and other health care provider groups to establish twenty-one prior authorization principles, which include: 

  • Establish a single, standardized form for physicians to submit prior authorization requests. 
  • Establish electronic systems for the submission of prior authorization requests. 
  • Require prior authorization requests to be completed by insurers within 48 hours of submission or receive automatic approval. 
  • Once approved, permit authorizations to remain in place for up to 12 months for people with chronic conditions, such as rheumatoid arthritis (RA). 
  • If a prior authorization request is denied, the member must be given clear instructions on how to file an appeal, including the information required and deadlines. 
  • Provide a process for expedited appeals, especially for urgent care services. 
  • Health plans should offer providers/practices at least one physician-driven, clinically-based alternative to prior authorization, such as, but not limited to, “gold-card” or “preferred provider” programs or attestation of use of appropriate use criteria, clinical decision support systems or clinical pathways. 

Current Trends

  • Patients surveyed by the Arthritis Foundation in 2017 indicated that prior authorization was one of the top two most burdensome insurance issues. 
  • In 2018, six organizations representing health care providers and health plans released a consensus statement to find opportunities to improve prior authorization programs. This collaboration builds upon the 21 principles outlined above. 
  • According to a 2018 American Medical Association survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers – and nearly a third (30 percent) said they wait three business days or longer. 
  • More than nine in 10 physicians (92 percent) said that the prior authorization process delays patient access to necessary care; and nearly four in five physicians (78 percent) report that prior authorization can sometimes, often or always lead to patients abandoning a recommended course of treatment. 
  • A vast majority of physicians (86 percent) believe burdens associated with prior authorization have increased during the past five years. 
  • Twenty-nine states have passed legislation requiring prescription drug prior authorization standards, including sixteen with electronic prior authorization standards.  

Share Your Story

Have you experienced this in your care journey?

Share Today
Advocate for What's Right

As an Arthritis Advocate, you’ll feel good about taking action to make health care more accessible. Help shift the policy and public perception that affects those living with arthritis.

I Want to Contribute
I Need Help
  • Donate


    Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life.

  • Volunteer


    Join us and become a Champion of Yes. There are many volunteer opportunities available.

  • Live Yes! INSIGHTS

    Live Yes! INSIGHTS

    Take part to be among those changing lives today and changing the future of arthritis.

  • Partner


    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.


Ways to Give

Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life. Whether it is supporting cutting-edge research, 24/7 access to one-on-one support, resources and tools for daily living, and more, your gift will be life-changing.

Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20 and you'll receive access to helpful tools..... and more. 

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Gift Planning

I want information on ways to remember the AF in my will, trust or other financial planning vehicles.


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

Become a Volunteer

More About Volunteering


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.


Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000


Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.


Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.


Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.


Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.


Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.