MGMA’s 2026 Regulatory Burden Report: Key Findings and the Future of Medication Access

A physician can prescribe the right medication in under 30 seconds. Getting that medication into the hands of the patient, however, can require a whole team of staff days, if not weeks, of administrative coordination.

This is what the latest Medical Group Management Association (MGMA) 2026 Regulatory Burden Report confirms, and what healthcare providers already know firsthand. Medication-related administrative work has become operationally overwhelming, with practices forced to build teams and workflows around payer requirements.

In short, healthcare organizations are operating in a world where medication access is a defining operational challenge. Meeting that challenge demands the important policy reform that MGMA advocates for; but it also requires adopting systems that are capable of coordinating complex access workflows effectively and at scale.

Medication access is reshaping healthcare operations

Medication access challenges already shape the operations of healthcare organizations today. According to the MGMA report:

• 90% of medical practices surveyed report increased prior authorization (PA) burden over the past year, and many have hired dedicated staff solely to manage PA workflows.
• Three of the top five administrative burdens were directly related to Medicare Advantage.

• 77% cited regulatory burden as a significant factor in physician burnout.

While MGMA’s report focuses broadly on regulatory burden, many of the operational pressures it describes are most visible in medication access workflows. These burdens can’t easily be solved through simple automation. The challenge is the sheer variability and fragmentation of the process itself: inconsistent payer requirements, shifting approval criteria, non-standard documentation requests, manual exceptions handling, and highly subjective review decisions. Every access journey can look different depending on the payer, therapy, reviewer, or patient circumstance.

That complexity is difficult to automate reliably. Moreover, workflows are disconnected and decisions often opaque. Organizations frequently lack visibility across the full medication access journey, making coordination and standardization difficult.

As a result, healthcare organizations are increasingly forced to devote operational resources to payer administration. PA, for example, now affects the core economics and operations of healthcare delivery such as staffing, clinician capacity, financial performance, and patient care.

What policy reforms can and can’t fix

MGMA appropriately calls for policy reform and greater payer accountability. However, many of these challenges exist beyond what policy reform alone can realistically solve.

Medication access today is a fragmented network of payers, portals, documentation requirements, appeals processes, specialty pharmacies, and constantly changing approval criteria. Worse, these often vary by therapy, insurer, and patient circumstance. Even in a more standardized regulatory environment, healthcare organizations would still need to coordinate complex workflows across multiple stakeholders and disconnected systems.

Administrative complexity is only one part of the challenge. Medication access teams are also increasingly responsible for helping patients find ways to pay for therapy, through benefits verification, reimbursement support, copay assistance, patient assistance programs, and the like.

This affordability part of the puzzle adds additional complexity across the access journey. Managing that requires systems that reduce operational friction and create visibility across the access journey for health systems.

Designing for medication access at scale

Since medication access has become core operational infrastructure, healthcare organizations need infrastructure designed accordingly. That starts with moving away from fragmented, task-based workflows spread across multiple teams juggling faxes, spreadsheets, and portals.

The question for healthcare organizations is what kinds of systems and workflows can best manage the complexity of medication access at scale. Health systems increasingly require capabilities that connect the entire access journey, from prescription to therapy start to long-term adherence. These include:

1. Reduced manual administrative work

Today, medication access teams spend enormous amounts of time on repetitive operational tasks like manually re-entering patient and clinical information across systems or coordinating follow-up across providers, pharmacies, and payers. Effective infrastructure should reduce that administrative overhead wherever possible by integrating systems and automating simple processes.

2. Coordination across stakeholders

Medication access coordination is inherently difficult because it includes so many stakeholders: providers, pharmacies, manufacturers, hubs, payers, and patients. People working on the same PA often use completely different systems and timelines. Organizations need infrastructure that connects those workflows without forcing teams to abandon the tools they already rely on.

3. Visibility across the access journey

Teams need to know what is happening across the access journey. Without that visibility, it’s difficult to figure out where and why patients get stuck and what approvals are at risk of falling through the cracks. Infrastructure must let teams know exactly where a case is, what step to take next, and where intervention is needed to keep therapy initiation moving forward.

4. Support for complexity and exceptions

Because medication access is variable and operationally complex, organizations need automation solutions that are capable of handling exceptions and helping teams navigate the situations where human judgment and intervention are required.

5. A better patient experience

Unexplained delays and fragmented communication directly affect whether patients begin and remain on therapy. Better infrastructure should help patients understand where they are in the process, what is required next, and who is responsible for helping them move forward.

A new model for medication access

MGMA’s report lays bare the challenges facing healthcare organizations and shows they are systemic in nature. As the organization argues throughout the report, meaningful policy reform is absolutely necessary to reduce payer-driven administrative burden and improve Medicare reimbursement and quality reporting structures.

At the same time, even in a more standardized and accountable system, medication access will remain a highly operational function that requires more automated, coordinated workflow management across the full access journey. Managing that complexity is a big challenge, but it also gives health systems an opportunity to fundamentally reimagine access workflows. The processes today are laborious and disconnected. But they don’t have to stay that way.

Photo by Vitaly Gariev on Unsplash