ASCO survey: Prior authorization leads to ‘indefensible delays’ in cancer care
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Prior authorization has widespread negative impacts on cancer care, an ASCO survey of oncology providers showed.
A majority of respondents indicated prior authorization requirements resulted in treatment delays, resulted in changes to treatment regimens and increased out-of-pocket costs. More than one-third of respondents reported prior authorization resulted in a patient death.
“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, FASTRO, FASCO, said in a society-issued press release. “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.”
The survey, distributed to ASCO members between June 27 and July 30, received 300 responses. The majority (55%) of respondents listed medical oncology as their primary clinical practice area, with comparable representation among community/hospital-based systems (35%), private practice (34%) and academic/university settings (29%). Survey respondents most frequently identified billing staff (31%) as initiating prior authorization.
The most common harms survey respondents reported included delays in treatment (96%) or diagnostic imaging (94%), patients being forced onto a second-choice therapy (93%) or denied therapy (87%), and increased patient out-of-pocket costs (88%).
Four in five (80%) respondents indicated prior authorization resulted in disease progression for a patient, and one-third (36%) reported it resulted in loss of life.
The survey also asked respondents about the challenges oncology practices experience while processing prior authorization requests. The most common included:
- Onerous documentation needed to demonstrate necessity (97%);
- Response delays from insurance companies (97%);
- Unsuccessful appeals (96%);
- Obstructive appeal processes (94%);
- Lack of clinical expertise by prior authorization reviewers (91%);
- Lack of clinical validity of prior authorization programs (91%); and
- Lack of transparency in the process.
“ASCO members’ growing concerns about the impact of prior authorization on individuals with cancer led us to collect and examine the latest data on their experiences,” Pierce said in the release. “In 2018, health plans and health provider organizations signed on to consensus principles for prior authorization reforms, but the plans have not implemented them. ASCO will continue to advocate for policies that protect patients and ensure access to the timely care they need, and we call on health plans to take up the reforms they agreed to.”
The survey also asked respondents to indicate which patient services could be expanded at their practice if the resources used to process prior authorizations could be reallocated. Common themes included seeing more patients, expanding supportive care services (ie, new patient navigation, financial counseling, patient education, nutrition counseling, psychosocial support), outpatient services, palliative care and research.
References:
- ASCO. ASCO Prior Authorization Survey Summary. Available at: https://old-prod.asco.org/sites/new-www.asco.org/files/ASCO-Prior-Auth-Survey-Summary-November-2022.pdf.
- ASCO. Nearly all oncology providers report prior authorization causing delayed care, other patient harms (press release). Available at: https://old-prod.asco.org/about-asco/press-center/news-releases/nearly-all-oncology-providers-report-prior-authorization. Published Nov. 22, 2022. Accessed Nov. 29, 2022.
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