JRW / Blog / Statistics

Prior authorization statistics, 2026.

Three sources cover nearly everything known about the prior authorization burden on practices: the AMA’s annual physician survey, CAQH’s index of transaction costs, and KFF’s analysis of Medicare Advantage data. Each figure carries its sample, and we add one measurement of our own.

Jeff Weinberg, JRW · Checked 22 October 2026

40prior authorizations per physician per week. AMA, 2025
13 hoursa week of physician and staff time on them
24 / 16 minper request by phone, fax or email, and by portal. CAQH
81.7%of appealed Medicare Advantage denials overturned. KFF

Volume and time.

40 (link to this figure)

Practices complete 40 prior authorization requests per physician per week, on average. The 2024 survey found 39.

Survey: American Medical Association, 2025. 1,000 practicing physicians, 400 primary care and 600 specialists, web survey, December 2025

Prescriptions included. Specialties with biologics, imaging or procedures run higher.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-per-week-40, checked 22 October 2026
13 hours (link to this figure)

Physicians and their staff spend 13 hours a week on prior authorization requests.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-hours-13, checked 22 October 2026
40% (link to this figure)

Four in ten physicians have staff who work only on prior authorizations.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-staff-exclusive-40, checked 22 October 2026
24 / 16 min (link to this figure)

A request takes 24 minutes by phone, fax or email, and 16 minutes through a health plan portal.

Survey: CAQH, 2024. Plans and providers, 2023 data

The highest portal time CAQH recorded for any transaction. A fully electronic request saves 14 minutes.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-minutes-24-16, checked 22 October 2026
65% (link to this figure)

Two in three physicians at least sometimes have to do a peer-to-peer review with the health plan.

Survey: American Medical Association, 2024. 1,000 physicians, December 2024

The 2025 survey summary does not report this figure. In 2025, only 16% of physicians who do peer-to-peer reviews said the plan’s peer often or always has the right qualifications.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-p2p-65, checked 22 October 2026

Cost per request.

$12.88 (link to this figure)

Provider cost of a manual prior authorization by phone, mail, fax or email. The plan’s side adds $3.41.

Survey: CAQH, 2024. 2024 CAQH Index, 2023 data

Through a portal, $8.93. Fully electronic, $5.38. CAQH puts the industry’s saving from electronic prior authorization at $515 million a year.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-cost-manual-1288, checked 22 October 2026
$5.38 (link to this figure)

Provider cost of a fully electronic prior authorization.

Survey: CAQH, 2024. 2024 CAQH Index

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-cost-electronic-538, checked 22 October 2026
$24.59 (link to this figure)

Median hourly pay of medical records specialists, before benefits and overhead.

Official: US Bureau of Labor Statistics, Occupational Outlook Handbook, 2025. Federal wage data, May 2025

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-wage-2459, checked 22 October 2026

Denials, appeals and outcomes.

32% (link to this figure)

Nearly one in three physicians say requests are often or always denied, up from 31% in 2024. 74% say denials have increased over five years.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-denied-often-32, checked 22 October 2026
21% (link to this figure)

One in five physicians always appeal a denial. Asked why physicians don’t appeal, 59% don’t expect to win based on past appeals and 52% don’t have the staff time.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-always-appeal-21, checked 22 October 2026
3.2 million (link to this figure)

Of more than 50 million Medicare Advantage prior authorization requests in 2023, 3.2 million were partly or fully denied.

Official: KFF analysis of CMS data, via the AMA, 2023. CMS data, Medicare Advantage only

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-ma-denied-3-2m, checked 22 October 2026
81.7% (link to this figure)

11.7% of Medicare Advantage denials were appealed in 2023. 81.7% of those appeals were fully or partly overturned.

Official: KFF analysis of CMS data, via the AMA, 2023. CMS data, Medicare Advantage only

Few denials were appealed, and most of the appeals that were filed succeeded.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-appeals-overturned-82, checked 22 October 2026
95% (link to this figure)

95% of physicians say prior authorization delays care. 79% say it at least sometimes leads patients to abandon treatment.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-care-delays-95, checked 22 October 2026
26% (link to this figure)

More than one in four physicians say prior authorization has led to a serious adverse event for a patient. 20% report a hospitalization. The 2024 survey found 29%.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-adverse-26, checked 22 October 2026
94% (link to this figure)

94% of physicians say prior authorization increases burnout, up from 89% in 2024.

Survey: American Medical Association, 2025. 1,000 physicians

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#pa-burnout-94, checked 22 October 2026

From our work.

One measured engagement and one calculator output.

17% to 9% (link to this figure)

First-time prior authorization denials at a nine-provider gastroenterology practice, before and after an agent took over assembling and submitting requests. Each coordinator got about three hours a day back.

JRW engagement: JRW case study, 2026. One engagement, 2026

The case study.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#jrw-denials-17-9, checked 22 October 2026
$139,632 (link to this figure)

Staff cost per year of prior authorization at a six-physician practice, at the AMA and CAQH defaults.

Our default: JRW, 2026

Prior authorization cost calculator: 40 requests per physician per week, 16 minutes each, a quarter reworked, medical-records wage plus 30% overhead. Staff time only. Denials avoided and care that is not delayed are worth more on top.

Cite
JRW, “Prior authorization statistics 2026”, https://jrw-tech.com/blog/prior-authorization-statistics#jrw-pa-cost, checked 22 October 2026

The labels.

Measured. Call logs, records or a trial, with a stated sample, from someone not selling a fix for the problem measured.
Measured, vendor data. A vendor’s own platform data, with a stated sample.
Survey. A survey or secret-shopper study, with a stated sample.
Official. Government statistics, statutes and regulations.
Legal analysis. A law firm’s or court’s account of a law or ruling. Not legal advice for your state.
Vendor figure. Published or repeated by a company that sells a related product, with no independent check. Some have no primary source we could find; the note says which. Where a calculator starts from one, its defaults table says so.
JRW engagement. Measured in one of our own client engagements. We sell the work being measured, so read it as one practice’s result, not a benchmark.
Our default. A number we chose, or a JRW calculator’s output at its default settings. The calculator page shows the assumptions.

To cite a figure, copy its cite line. Anchors are stable. Corrections: jeff@jrw-tech.com.

Questions.

Which survey is the AMA figure from?: The AMA’s 2025 prior authorization physician survey, published in May 2026. 44 questions, web-based, December 2025, 1,000 practicing physicians from a Medscape panel, 40% primary care and 60% specialists. The AMA runs it every year. The peer-to-peer figure comes from the 2024 edition.
Is the CAQH time for the whole process?: No. It is the time to submit the request through each channel. Chasing the decision, resubmitting a denial and recording the result come on top. That is why the AMA’s 13 hours a week is more than 40 requests times 16 minutes.
Do the KFF denial figures apply to commercial plans?: No, Medicare Advantage only. Commercial plans do not publish comparable data. The AMA survey covers all payers but asks physicians what they see rather than counting determinations.
Can I cite these?: Cite the AMA, CAQH or KFF for their figures. Cite JRW for the case measurement, the calculator output and this page.

Run the numbers for your own physicians.

The calculator starts from the AMA and CAQH figures and takes your practice’s numbers.

Open the prior authorization calculator

Prior authorization statistics, 2026.

Practices complete 40 prior authorization requests per physician per week, on average. The 2024 survey found 39.

Physicians and their staff spend 13 hours a week on prior authorization requests.

Four in ten physicians have staff who work only on prior authorizations.

A request takes 24 minutes by phone, fax or email, and 16 minutes through a health plan portal.

Two in three physicians at least sometimes have to do a peer-to-peer review with the health plan.

Provider cost of a manual prior authorization by phone, mail, fax or email. The plan’s side adds $3.41.

Provider cost of a fully electronic prior authorization.

Median hourly pay of medical records specialists, before benefits and overhead.

Nearly one in three physicians say requests are often or always denied, up from 31% in 2024. 74% say denials have increased over five years.

One in five physicians always appeal a denial. Asked why physicians don’t appeal, 59% don’t expect to win based on past appeals and 52% don’t have the staff time.

Of more than 50 million Medicare Advantage prior authorization requests in 2023, 3.2 million were partly or fully denied.

11.7% of Medicare Advantage denials were appealed in 2023. 81.7% of those appeals were fully or partly overturned.

95% of physicians say prior authorization delays care. 79% say it at least sometimes leads patients to abandon treatment.

More than one in four physicians say prior authorization has led to a serious adverse event for a patient. 20% report a hospitalization. The 2024 survey found 29%.

94% of physicians say prior authorization increases burnout, up from 89% in 2024.

First-time prior authorization denials at a nine-provider gastroenterology practice, before and after an agent took over assembling and submitting requests. Each coordinator got about three hours a day back.

Staff cost per year of prior authorization at a six-physician practice, at the AMA and CAQH defaults.

Run the numbers for your own physicians.