The report, which tracks prior authorization activity across thousands of U.S. practices, identifies a clear divide between therapy initiation and continuation. While most specialties see higher approval rates for established patients, initiation remains a primary point of access friction. Retina specialists bucked this trend, reporting higher approval rates for new starts than for ongoing treatments.

Complexity in drug formulations and delivery methods—such as the shift to subcutaneous administration—further complicates the landscape. Immunoglobulin therapies and chronic inflammatory biologics showed the most variable performance, suggesting that manufacturers must monitor access at the individual product level rather than relying on broad brand-class metrics. Payer-level data revealed even starker disparities: while the median resolution time sits at 2.1 days, the bottom 10% of payer-specialty combinations require over 8.8 days to reach a decision. SamaCare CEO Syam Palakurthy noted that these variations stem from inconsistent documentation requirements and payer policy interpretations, emphasizing that administrative barriers remain a critical hurdle for patient treatment starts.