Prior authorization (PA) is one tool employed by commercial payers and managed care organizations (MCOs) to optimize the utilization of various high-dollar or potentially low-value services covered under typical comprehensive medical coverage. PA can be an effective cost-control tool, but it also can increase the administrative burden and long-term costs. The Massachusetts Association of Health Plans recently engaged Milliman to model the potential cost impacts from generally limiting or eliminating PA in the commercial and Medicaid markets. In this report, we discuss: 

• Background on PA
• Medical and drug allowed cost results
• Impacts to premiums and member cost sharing
• Key considerations

This report was commissioned by Massachusetts Association of Health Plans.