Internal medicine’s prior-authorization problem is a problem of scope. No other specialty manages as wide a range of chronic adult conditions — and that breadth means prior authorization requirements attach to almost every drug class, imaging order, and specialist referral the internist generates.
The challenge isn’t mastering one drug class’s PA criteria. It’s running authorization across dozens simultaneously, without the infrastructure a high-volume specialty practice would build for a narrower scope.
The numbers in internal medicine
The AMA’s 2024 Prior Authorization Physician Survey is the benchmark cross-specialty dataset, and it is directly representative of internal medicine:
- 39 prior authorizations per physician, every week.
- ~13 hours per physician per week on prior authorization — nearly two full business days.
- 93% of physicians say PA delays patient care.
- 82% say PA can lead patients to abandon treatment.
- 29% report that PA led to a serious adverse event.
Penn LDI and AJMC analyses tracking Medicare Part D coverage found that GLP-1 prior authorization went from fewer than 5% of prescriptions to approximately 100% in under two years — hitting internal medicine at high volume, given its role in managing diabetes and obesity.
Why internal medicine is different
- No single drug class dominates. A rheumatologist can specialize the practice’s PA infrastructure around biologics. An internist runs PA across antidiabetics, cardiovascular drugs, specialty referrals, imaging orders, and DME simultaneously. There is no single template; every category requires its own documentation shape.
- The GLP-1 wall hit first. Because internal medicine manages both type 2 diabetes and weight management, the shift from near-zero to universal GLP-1 PA in Medicare landed squarely here — and landed faster than most practices could build process to absorb it.
- Referral and imaging PA. An internist ordering a specialist referral, a CT, or an MRI is initiating PA requirements that delay the next step in the patient’s care — not just the medication currently being prescribed.
- No dedicated PA staff. High-volume specialty practices build authorization teams around their drug classes. Internal medicine practices typically don’t. The PA burden falls on medical assistants and staff already doing everything else.
What it costs
The cost is 13 hours a week of physician and staff time spread across a high-volume, wide-scope authorization load. At roughly $10.81 per manually processed authorization (CAQH 2023), a single internist running 39 authorizations a week spends roughly $420 weekly in direct processing cost alone — before counting the clinical cost of delayed medications, deferred imaging, or specialist referrals that didn’t reach the specialist. The 82% treatment-abandonment signal in the AMA data means a meaningful share of patients who could receive care don’t, because the authorization process outlasts their willingness to wait.
How to cut the wait
Internal medicine’s PA problem isn’t solved by learning one drug class’s criteria better. It’s solved by infrastructure: automated assembly across all categories, so each drug class doesn’t require a separate manual effort per submission. Artificer Health:
- Assembles the packet for each drug class — GLP-1 documentation, specialty drug step-therapy histories, imaging clinical rationale, DME justification — from the patient chart, without requiring staff to know each payer’s format for each category.
- Matches it to the payer’s criteria so first-pass submissions go in complete, reducing the documentation-request loops that waste the most time.
- Tracks pending authorizations across the full panel so nothing lapses and no re-authorization requires a manual calendar reminder.
For an internal medicine practice, the payoff isn’t measured in one drug class — it’s 13 hours back per week, across every authorization the practice runs.
Sources: AMA 2024 Prior Authorization Physician Survey (n=1,000; sample representative of primary/internal medicine); Penn LDI / AJMC GLP-1 PA surge analyses (2024–2025); CAQH 2023 Index.