Managed Care Playbook Proposes GLP-1 Prior Authorization Friction Index to Streamline Access and Reduce Patient Abandonment

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are highly effective for weight loss and diabetes management, but their high cost often leads to access barriers. Prior authorization (PA) processes, while intended to ensure appropriate use, frequently cause significant delays and patient abandonment. This friction often stems from inefficient workflow management rather than strict coverage criteria. A critical gap exists in systematically identifying and mitigating these operational bottlenecks to improve patient time-to-start metrics without compromising clinical safeguards.

This commentary article proposes a novel framework for managed care organizations and pharmacy benefit managers. The authors synthesized insights from existing utilization management (UM) and claims metadata to conceptualize a reproducible PA Friction Index. They analyzed common pain points in the prior authorization workflow, differentiating between policy-driven restrictions and operational friction. The work outlines the index's measurable domains and signals, discusses the appropriate role of automation, and provides a practical 90-day implementation checklist for reducing rework and standardizing criteria.

The proposed PA Friction Index offers a structured approach for payers to quantify and pinpoint workflow inefficiencies in GLP-1 prior authorization. It leverages existing UM and claims metadata to identify where friction concentrates, allowing for targeted interventions. Key measurable signals for the index include time to decision, patient abandonment rates, and appeal rates. > The article emphasizes that automation can both help and harm, advocating for guardrails to prevent unintended friction, particularly in equity-sensitive areas. The accompanying 90-day implementation checklist guides organizations through standardizing PA criteria, expanding electronic PA (ePA) adoption, and actively reducing rework. Continuous monitoring of outcomes such as time to decision, abandonment, and appeals is central to the playbook, aiming to improve patient access without loosening clinical safeguards. This framework provides a practical, reproducible method to enhance the efficiency and equity of GLP-1 therapy access.