Pull-through Is Learned: What a Rejection Teaches the Office

Why Rx and PA hygiene is a practice-level asset—and how it’s built (or eroded) one event at a time

Pharmaceutical vice presidents, executive directors, brand leads, marketing leads, and commercial leads:

Every rejection is a lesson.

A prescription hits a wall on its way to the patient. A prior authorization (PA) nobody knew was required. A diagnosis code that didn’t travel with the script. We’ve written about what that moment costs the patient—the delay, the abandonment, the exit from therapy no one sees until it’s too late.

Perception is being formed in that moment, and it outlasts the prescription. The office is learning. The staff member working on the rejection is forming a sense of what this therapy is like to deal with. The prescriber is deciding whether the fight is winnable—and at what cost. When the rejection dead-ends, the lesson is this: This therapy is hard, and there’s an easier one to prescribe next time. When it surfaces in time to act, with the reason and the fix attached, the lesson is the opposite: This is recoverable, and the path works.

Same event, opposite educations. A brand doesn’t get to choose whether practices learn from friction—only which lesson gets taught.

Hygiene is a practice-level asset.

Call it Rx and PA hygiene: the routine work of getting prescriptions and prior authorizations right—complete, correct, documented, on time—so approval becomes the default rather than the exception. It is the discipline underneath pull-through, and it comes down to two capabilities:

Getting it clean the first time. The PA submitted complete, with documentation attached. The diagnosis code that travels with the script. The requirement anticipated rather than discovered. Every rejection prevented at the source is a delay the patient never experiences and a recovery nobody has to run.

Recovering well when rejection happens anyway. A denial is a status, not a verdict. We’ve made that argument about “not covered” rejections,[1] and it’s just as true of prior authorizations. Resubmitting with what was missing. Appealing with the right artifact while the patient is still waiting, not already gone.

Practices are not equally good at these two things, and the difference shows up in your numbers as pull-through—or its absence. That’s why hygiene is an asset. Assets can be built. Assets can also be lost. Three forces work against it:

1. Perception tells the office to stop fighting.

Sixty-two percent of physicians told the American Medical Association they don’t appeal denials because experience taught them appeals are unlikely to succeed.[2]

The outcomes data: Among Medicare Advantage PA determinations for medical services in 2024, only 11.5% of denials were appealed; and 80.7% of appeals won.[3] Hospitals that fought private-payer denials ultimately overturned 54.3%.[4] On HealthCare.gov marketplace plans, insurers denied 19% of in-network claims; fewer than 1% were ever appealed.[5]

Denials are contested far less often than they are winnable.

A practice that fought unsupported appeals and lost isn’t imagining things. It has learned from its own data—treating every unattempted win as a missed sample.[6] And even a winnable fight competes for staff time with every other therapy’s paperwork.[2] To change the behavior, winning has to get cheaper, not just more likely.

The pharmacy side looks the same. Of more than 200,000 branded prescriptions rejected for prior authorization at the pharmacy in 2024, barely half were ultimately approved—only 7% the same day, with a median of six days to resolution.[7] The office usually hears about it late, from a frustrated phone call or a follow-up visit where therapy never started: the version of events with no reason and no remedy attached. That is what sets the practice’s sense of what getting a patient onto this therapy is like.

Where that education ends is documented: 75% of providers report often avoiding newer medications—even when evidence supports them—because of the PA difficulty they’ve come to expect, and more than a third switch medications when PA delays occur.[8] Friction the practice expects doesn’t just cost the prescription in front of you. It changes the next one before it’s written.

2. The practice forgets.

The asset lives in people, and the people leave. Ask practice leaders which roles churn most: medical assistants and front-office staff—exactly the people who work the PA queue, chase documentation, and run down rejected claims.[9] Only about a third of practices have staff dedicated to prior authorization at all.[2]

When that person leaves, the working knowledge goes, too: which plans require what, which denials are worth contesting, where the Letter of Medical Necessity template lives. Whatever the office learned about your brand’s access pathways walks out the door, and the new hire’s education starts with whatever the next rejection teaches.

3. The resources exist but don’t always arrive.

Manufacturers spend an estimated $5 billion a year on patient support programs; about 3% of patients use them.[10] Fewer than half of healthcare providers say they’re very aware these services exist.[11] Nearly half of physicians cite insufficient staff time or resources as a reason denials go uncontested.[2]

The Letter of Medical Necessity template exists. The PA checklist exists. Co-pay support exists. They sit on a portal, on a website, in an email, in a rep’s bag, in a folder from a lunch-and-learn—separated from the moment of need by exactly the distance that makes them unused.

A resource the busiest person in the office has to remember, at the moment they’re least free to look, is no resource at all.

What actually changes practice behavior

Nearly 300 studies of clinician feedback point the same way[12]: Feedback changes behavior when it’s about the individual’s own performance, arrives close to the event, comes through a credible channel, and carries a specific next action.

A notification triggered by a discrete event—the PA rejection, the missing diagnosis code, the reversal, the script never picked up—is by construction individual, timely, and specific. Attach the right resource and it becomes actionable. Deliver it in the channels the office already works in, to the prescriber and the staff who run the queue, and it reaches the people whose behavior decides the outcome.

That’s a feedback loop running on real events, and each notification does two jobs: It gives this patient’s prescription a path forward, and it gives the office one more repetition of what clean looks like—and proof that recovery works. The next prior authorization goes out more complete. The next denial gets contested by people who expect to win because they have. And because the loop is attached to events rather than employees, it keeps teaching after the person who knew the ropes moves on.

The lift that compounds

A rejection detected and recovered is a prescription saved—real, immediate, and from demand the brand already earned. The same event, surfaced with support attached, also recalibrates what the office believes is winnable, rehearses the habits that prevent the next rejection, and survives the turnover that erases everything else.

The individual save is the visible return. The practice that gets better is the compounding one.

This is why we build the way we do at Aventria. ReCaptRx^™ detects discrete events along the prescription journey—the rejection, the reversal, the fill that never happened—and notifies the prescriber and their team in the channels they already use, with actionable, compliant resources attached when they’re needed. One event, two effects: The patient in front of you gets a path forward, and the practice around them gets a little harder to break.

Dave Dierk is Co-President of Aventria Health Group and a 30-year thought leader in pharmaceutical sales and marketing. If your brand’s field and access teams want to see what “hygiene” looks like for your therapy, Dave welcomes the conversation: dave.dierk@aventriahealth.com.

References

1. Aventria Health Group. When “not covered” isn’t the last word. Accessed July 30, 2026. https://www.aventriahealth.com/not-covered-isnt-always-the-last-word

2. American Medical Association. Over 80% of prior auth appeals succeed. Why aren’t there more? Accessed July 30, 2026. https://www.ama-assn.org/practice-management/prior-authorization/over-80-prior-auth-appeals-succeed-why-aren-t-there-more

3. KFF. Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024. Accessed July 30, 2026. https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024

4. Premier Inc. Trend alert: private prayers retain profits by refusing or delaying legitimate medical claims. Accessed July 30, 2026. https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims

5. KFF. Claims denials and appeals in ACA marketplace plans in 2024. Accessed July 30, 2026. https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024

6. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215.

7. Wang Y, Levy JF, Mattingly J, Anderson G. Prior authorization and associated delays and denials of branded medication dispensation. JAMA Health Forum. 2026;7(4):e260760. doi:10.1001/jamahealthforum.2026.0760

8. Salzbrenner S, Scheier LM, Qiu F. Prior authorization of medication and its influence on provider behavior: latent class analysis. J Med Internet Res. 2025;27:e75361. doi:10.2196/75361

9. Harrop C. MGMA Stat. Can staff turnover continue to be tamed in medical practices into 2026? Accessed July 30, 2026. https://www.mgma.com/mgma-stat/can-staff-turnover-continue-to-be-tamed-in-medical-practices-into-2026

10. Soltero J, Lovinguth B. Unleash the full potential of your patient support services (PSS): streamline operations for better outcomes. IQVIA. 2025. Accessed July 30, 2026. https://www.iqvia.com/-/media/iqvia/pdfs/us/article/iqvia-pss-operations-article-2025.pdf

11. Chiang K. Patient support programs: bridging the awareness gap. May 14, 2025. CoverMyMeds Insight. Accessed July 30, 2026. https://www.covermymeds.health/articles/healthcare-research/bridging-awareness-gap-for-patient-support-programs

12. Ivers N, Yogasingam S, Lacroix M, et al. Audit and feedback: effects on professional practice. Cochrane Database Syst Rev. 2025;3(3):CD000259.

Prior Authorization Rejection