The prior authorization process can delay cancer care, leading to disease progression and death, according to a survey conducted by the Association for Clinical Oncology, an organization affiliated with the American Society of Clinical Oncology (ASCO).1
Most survey respondents (96%) said prior authorization has led to delays in cancer treatment, 80% said prior authorization has enabled disease progression, and 36% said prior authorization has led to patient deaths.
The survey was completed by 300 ASCO members working in community or hospital-based health network/systems (35%), private practice (34%), and academic or university (29%) settings.
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A majority of respondents said that, on average, prior authorizations are approved 78% of the time, and a payer response is received within 5 business days. However, most respondents also said prior authorizations are delayed by more than 1 business day 42% of the time.
Respondents said the prior authorization process has a range of negative effects on patients and their care, including:
- Delaying treatment (96%) and diagnostic imaging (94%)
- Denying patients cancer therapy (87%), genetic testing (76%), supportive care (72%), or cancer screening (61%)
- Forcing patients to receive a second-choice therapy (93%)
- Increasing patients’ out-of-pocket costs (88%)
- Forcing patients to an alternate site of service (80%)
- Leading to hospitalizations or emergency room visits (74%)
- Prompting patients to abandon care (64%)
- Leading to cancer progression (80%) and death (36%).
“The survey results confirm what ASCO members have been experiencing first-hand for years, which is that large numbers of patients face indefensible delays or denials of cancer care,” ASCO Board Chair Lori J. Pierce, MD, said in a statement.2 “We now have a clearer picture of the extent to which those hurdles lead to poorer patient outcomes, including reports of deaths. It would be unconscionable for policymakers to leave current prior authorization requirements and their effects on people with cancer unexamined.”
References
1. ASCO prior authorization survey summary. Association for Clinical Oncology. Published November 22, 2022. Accessed November 28, 2022.
2. Nearly all oncology providers report prior authorization causing delayed care, other patient harms. American Society of Clinical Oncology. News Release. Published November 22, 2022. Accessed November 28, 2022.
This article originally appeared on Cancer Therapy Advisor
