When Prior Authorization Gets in the Way: What Happened When One System Removed It

Prior authorization—the requirement that insurance companies approve a treatment before you can get it—is meant to control costs. But for people with Type 1 diabetes, it often means waiting weeks or months to start using a continuous glucose monitor (CGM) or insulin pump, even when a doctor has prescribed it. A new study examined what happens when that requirement temporarily disappears.

Researchers looked at 105 adults with Type 1 diabetes at a safety net clinic in California. When prior authorization was required, doctors wrote 32 prescriptions for CGMs. Nearly half of them (46%) were delayed, taking an average of 82 days to get approved. One in five prescriptions (21%) were denied outright.

A computer system failure gave researchers an unexpected opportunity to study what happens without prior authorization. For 18 months, Medi-Cal suspended its prior authorization requirement for CGMs and insulin pumps, including automated systems. During this period, 27 new CGM prescriptions were written.

The difference was striking. Delays dropped significantly—from an average of 82 days down to 40 days. While delays didn't disappear completely, approval times improved noticeably. More importantly, people actually started using these devices: CGM use jumped from 36% of patients to 81%, and the number of people using insulin pumps increased from 16 to 25 patients.

Faster access to technology correlated with improved blood sugar management. The average HbA1c—a three-month measure of blood sugar control—dropped from 9.1% to 8.5%. This 0.6 percentage point improvement is clinically meaningful and suggests that removing barriers to technology helps people manage their diabetes more effectively.

The researchers note that this happened in a population facing significant health inequities. The fact that removing one administrative barrier made a measurable difference underscores how much prior authorization can interfere with diabetes care in underserved communities.

Even after prior authorization was eliminated, some delays remained. This tells an important story: prior authorization isn't the only obstacle to accessing diabetes technology. Cost, insurance coverage policies, device availability, patient education, and other structural factors all play a role.

The researchers describe their findings as evidence of 'persistent structural inequities,' meaning that while removing prior authorization helped, it didn't solve every problem. The study suggests that reducing administrative burden is one important piece—but not the only piece—of improving access to life-changing diabetes tools.

Source: Diabetes care. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.