Study of prior authorization’s impact on cancer treatment reveals ‘signal of danger

More than one in five people with cancer did not receive clinician-recommended care due to prior authorization requirements, according to study results.

Prior authorization also led to care delay — many of them lasting 2 weeks or longer — as well as increased patient anxiety and administrative burden, findings of a survey-based cross-sectional study showed.

prior authorizations, with 73% of these delays exceeding 2 weeks. In 63% of cases, recommended care ultimately was provided. Prior authorization led to increased anxiety among survey respondents, as well as decreased trust in both the health care system and insurance companies.

Sixty-seven percent of the respondents had to become personally involved in the process, and 20% spent more than 11 hours dealing with prior authorization. It’s important to consider the context, as these delays and these efforts on the part of patients and their caregivers are occurring in the midst of cancer diagnosis and treatment.

Healio: Most survey respondents rated the prior authorization experience as bad or horrible. What are the implications of this finding?

Thom: At the most basic level, these findings shed light on the harms experienced by patients. For starters, their care and their medications are being delayed. Then, not only do patients have to take time out of their day — as they are going through treatment — to manage the multiple stakeholders involved in the prior authorization process, they also are experiencing anxiety about the process. They don’t know if their care will be covered and — if it is not covered — they don’t know if they will be able to afford care.

Healio: Do these findings reveal a potential danger of delayed cancer care due to prior authorization?

Thom: There definitely is a signal of danger, particularly related to potential delays in diagnosis, necessary imaging and symptom management. For example, cancer-related symptom management often focuses on alleviating pain and nausea. Patients who experience delays in receipt of these medications may instead have to opt for more costly alternatives — including ED or urgent care visits — to manage their symptoms. We are working on research to understand the downstream effects of prior authorization on patients.

Healio: What are the potential solutions?

Thom: In a perfect world, there would be no prior authorization in the context of acute illness: Payers could just allow providers to make treatment decisions for their patients. In reality, a number of actions are needed to address the situation. One is awareness of the problem. Our study is a good first step in centering the patient perspective to learn firsthand the real-life physical and psychosocial impacts of insurance companies’ business strategies. Future patient-centered research — with a sample more diverse than the one in our study — is needed to quantify and characterize the downstream consequences of prior authorization. Policy efforts to increase prior authorization transparency and the timeliness of decisions also are