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Prior authorization, a form of utilization management, is designed in part to be a check on rising healthcare costs with the consumer in mind. That’s laudable – except the process doesn’t work for the patient in the way that it could. Rather, the rules have mostly been written by the insurers, who may quietly keep their thumbs on the scale. Patients first, right? Fair. But, then why does the house always seem to come out on top in the end?