As a doctor, I spend too much time talking to insurers. Patients are the ones who suffer.

My patient was a young teenager who had been sick for weeks. We ultimately diagnosed her with an aggressive, rare disorder of the blood vessels that can restrict blood flow and damage vital organs.

She received Remicade, a targeted, immunosuppressive medication known as a biologic during her hospitalization, and it worked. Her fevers abated, her energy returned, and her labs showed dramatic improvement. Yet, despite the patient’s visible improvement during her hospital stay, her insurance provider denied payment for her Remicade treatments when she went home.

After an initial letter explaining the necessity of her medication, followed by a 75-minute phone call with her insurance company three weeks later, we ultimately got her medication approved, four weeks after we prescribed it. Fortunately, she was only one day late for her monthly dose.

Unfortunately, I have many other patients whose struggles with insurance over medication coverage haven’t ended so well.

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As a pediatric rheumatologist, I care for children with rare forms of chronic illness for which we now have highly effective therapies. But too often, my patients can’t access these effective therapies because insurers put up many barriers to coverage.

Therapies like Remicade have revolutionized the treatment of debilitating inflammatory diseases, giving patients hope and access to a full life, free of pain and suffering. But despite being the standard of care in severe blood vessel inflammatory disorders, arthritis, and most other rheumatologic conditions I treat, biologics are expensive and typically require prior authorization, an onerous process by which insurers require health-care providers to obtain advance approval from the insurer before prescribing a medication or other medical service. Without that, insurers won’t pay. Given that Remicade infusions cost $75,000 to $150,000 for one year of treatment, very few patients can afford it out of pocket.

Prior authorizations are endured by specialists across medicine. They can halt chemotherapy in cancer care and block drugs for skin diseases like psoriasis. People with allergies, heart disease, and diabetes may find their care delayed or stopped by these rules.

The goal of prior authorizations, of course, is to cut costs and unnecessary prescribing. But it has increasingly devolved into a time-consuming system of hurdles for health-care professionals that delays access to effective treatments.

Depending on the disease and its severity, these delays — or eventual denials of critical medication — can be life-threatening. In a 2022 survey by the American Medical Association, physicians reported that 94% of patients subject to the prior authorization process experience a delay in access to necessary care, 33% of physicians reported these delays led to a serious adverse event, and 80% reported that, in some cases, patients simply abandon the treatment.

These delays can be life-threatening.

Patients have been so frustrated that they have turned to shaming insurers on social media to get their medications approved.

The prior authorization process is hurting physicians, too. Physicians and our staff spend an average of 14 hours each week completing prior authorizations. This is valuable time lost that could otherwise be spent directly caring for patients. What’s more, this time theft is not a one-time occurrence, as prior authorizations are typically required at least annually for renewals of existing therapies. For patients who need combination therapy or medication changes, multiple prior authorization procedures are required each year.

With the U.S. facing severe shortages of health-care workers, it is hard to overstate the value of reserving clinicians’ time for direct patient care, rather than navigating through approvals that should be straightforward in a case like my patient’s.

And while prior authorization is meant to contain costs, evidence shows that it actually leads to the opposite, as treatment delays force patients to schedule more office visits, or even go to the emergency room.

Last summer, the U.S. House Committee on Ways and Means approved the federal Health Care Price Transparency Act of 2023 (HR 4822), which includes provisions to streamline and modernize the prior authorization process in Medicare. Pennsylvania adopted Act 146 of 2022, joining 38 other states with prior authorization reform legislation, including requirements for insurers to respond to requests in a timely manner.

Despite this progress, my patient still waited a month for her Remicade. But with Act 146 effective as of Jan. 1, there is hope to alleviate these dangerous care delays. Gov. Josh Shapiro’s administration must enforce Act 146 immediately. Call your congressional representative to advocate for similar legislation at the federal level. We cannot celebrate the revolutionary impact of lifesaving medications if they are not reaching our patients.

We must continue to advocate, on both the state and federal levels, for a more streamlined process for prior authorization. One with increased transparency and improved communication. One free of draining phone calls and desperate online pleas. In short, a process that ensures every patient in need can benefit from life-changing therapies.

Dori Abel is an associate fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania and a pediatric rheumatology fellow physician who cares for children with autoimmune and autoinflammatory diseases at Children’s Hospital of Philadelphia, where she is also an affiliate trainee at CHOP’s PolicyLab.