Modernizing Prior Authorization to Boost Transparency

Episode Summary In this episode of the MedCity Pivot Podcast, host Arundhati Parmar sits down with Javier Gonzalez (Abarca Health) and Tanvi Patel (Amazon Pharmacy) to unpack one of healthcare's most frustrating processes: prior authorization. The conversation explores how outdated systems, lack of transparency, and fragmented communication are eroding patient trust and delaying care. From policy complexity and data gaps to operational risks, the guests break down why prior authorization remains such a challenge—and what it will take to modernize it at scale. They also highlight the critical role of transparency, interoperability, and consumer expectations in shaping the future of healthcare. With insights from both payer and pharmacy perspectives, this episode paints a clear vision of a more patient-centered system where access to medication is faster, clearer, and more trustworthy Links & Resources Connect with Arundhati Parmar [email protected]  https://twitter.com/aparmarbb?lang=en https://medcitynews.com/ Keywords prior authorization healthcare transparency patient trust interoperability digital pharmacy healthcare innovation medication adherence health tech ePA patient experience healthcare systems PBM reform Amazon Pharmacy Abarca Health Episode Highlights 00:00–00:25 – Introduction to prior authorization challenges and patient frustration 00:01–00:49 – Overview of modernization efforts in healthcare systems 00:01:27–00:03:31 – The three core challenges: policy complexity, data quality, operational risk 00:04:11–00:04:29 – Real-life impact: delays in critical care (cancer case) 00:04:36–00:05:22 – How prior authorization erodes patient trust 00:05:59–00:07:00 – Medication adherence begins before the first dose 00:07:00–00:07:18 – 20–30% drop-off due to prior authorization failures 00:07:18–00:07:39 – Transparency as the key to patient engagement 00:08:20–00:09:45 – Benefits of electronic workflows (60–70% efficiency gains) 00:11:18–00:12:24 – What should be eliminated in a redesigned system 00:12:47–00:13:55 – Employers' role in improving benefit transparency 00:15:23–00:16:21 – Rise of modular PBM models and industry shifts 00:20:46–00:22:11 – Misaligned incentives across healthcare stakeholders 00:23:51–00:24:45 – Consumer expectations reshaping healthcare timelines 00:25:14–00:26:11 – The future: invisible, frictionless prior authorization