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The conversation explores how outdated systems, lack of transparency, and fragmented communication are eroding patient trust and delaying care.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

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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

• 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