Prior Authorization Harms Cancer Care, Radiation Oncologists Say

TOPLINE:

Prior authorization may cause treatment delays for patients, prompt physicians to choose less optimal treatments, cause patients to abandon treatments, and result in adverse events and sometimes death, according to the latest survey of US radiation oncologists.

METHODOLOGY:

• The physician specialty with the highest rate of nondrug prior authorization is radiation oncology, found a study of a major Medicare Advantage private insurers, raising concerns about the impact on the 1 million US patients who receive radiation treatments for cancer every year.
• An online survey was sent to all 4601 US-based radiation oncologists in the American Society for Radiation Oncology (ASTRO) member database, with 754 respondents completing more than half of the questions (response rate, 16.4%) between September 2024 and October 2024.
• Survey participants represented both academic (47%) and private (51%) practices across different community types, including urban (49%), suburban (39%), and rural (13%) settings, with demographic and practice characteristics representative of the general ASTRO membership.
• The survey was specific to prior authorization and addressed prior authorization generally, after previous surveys found similar patterns among private insurers for Medicare Advantage and other plans.

TAKEAWAY:

• Prior authorization resulted in adverse events for patients of 30% of physician respondents, including emergency room visits, hospitalization, or permanent disability, with 7% of physicians reporting it as a contributing factor to patient deaths.
• Prior authorization drove 82% of responding radiation oncologists to resort to less optimal treatments than initially prescribed, with 65% reporting this occurs in more than 10% of cases, up from 32% in 2019.
• More patients face delays from prior authorization, said 68% of physicians, compared with 52% in the 2020 survey, with average delays lasting 5 days or longer in 2024.
• Rates of initial approvals and overturned denials are up, said responding doctors, with 71% of prior authorization requests initially approved and 73% of denials overturned on appeal.

IN PRACTICE:

“Prior authorization also creates barriers to securing approvals for medicines that are needed to help with the effects of cancer treatment,” the authors of the executive summary of the survey results wrote. These include anti-nausea drugs, mucosal protectants, erectile dysfunction meds, topical prescription skincare, and pain medicine.

SOURCE:

This survey was led by ASTRO in Arlington, Virginia. Its results were published online on December 4, 2024, as an executive summary.

LIMITATIONS:

The survey’s primary limitation was the 16.4% response rate from the surveyed radiation oncologists, which could have potentially introduced response bias. Additionally, while the respondents were representative of the general ASTRO membership, the findings may not have fully captured the experiences of nonmember radiation oncologists.

DISCLOSURES:

This survey was conducted by ASTRO, which advocates for federal policy reforms to prior authorization for Medicare Advantage plans, specifically a pair of bipartisan bills pending in the US House and Senate, “Improving Seniors’ Timely Access to Care Act of 2024.” No additional conflicts of interest were reported in the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.