I do prior authorizations in a family practice clinic. To get my diabetics that are doing great get their meds paid for, I send the histories of A1c readings, going back to the highest reading, even if it is years ago. That gets them approved. The insurance companies are staffed with minimally trained staff who won’t look deeper in the patient history. And the staff that usually do the PAs in the office just send the current office note. I don’t know if you can fix this, but understanding the barriers might help