Date of Award

3-27-2026

Embargo Period

7-1-2027

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Elinor Borgert

Second Advisor

Jami Jones

Third Advisor

Trudie Milner

Abstract

Prior authorizations (PAs) are used to control healthcare costs but often create significant administrative burdens. In hemophilia care, timely access to specialty medications is critical, yet Hemophilia Treatment Centers (HTCs) frequently navigate payer-driven PA requirements that delay and disrupt care. This study examined how PA processes affect patient care and provider workloads. Twenty clinical and non-clinical staff from federally designated HTCs across the United States were purposively recruited for virtual, semi-structured interviews. Interviews were recorded, transcribed, and de-identified. Data were analyzed using conventional content analysis with independent coding by two investigators, supported by Dedoose software. Descriptive statistics summarized participant characteristics, and labor- time and cost estimate was estimated by annualizing labor costs based on mean weekly hours spent on PAs and position-specific wage rates. Thematic analysis identified themes related to PA challenges and care-delivery burden. The mean weekly time spent on PAs was 10.52 hours per participant. Eighty-five percent reported burnout related to PAs. The annual labor-time and cost estimate per participant ranged from $4,795 to $20,718. Findings emphasize the need for more efficient, clinically informed PA processes to reduce administrative burden and care delays, while supporting the case for greater insurer education at the national level

Rights

Copyright is held by the author. All rights reserved.

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Available for download on Thursday, July 01, 2027

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