Study Finds Prior Authorization Hinders Cancer Care, Causes Delays and Anxiety

More than one in five people with cancer were unable to receive recommended care due to prior authorization requirements, according to findings of a new study. The study, led by Bridgette Thom, PhD, a senior research specialist at Memorial Sloan Kettering Cancer Center, aimed to shed light on the patient perspective and examine the impact of prior authorization on cancer care.

In the survey-based cross-sectional study, Thom and colleagues surveyed 178 individuals with cancer to gather their insights on how prior authorization affected their care. The results were striking, with 22% of patients reporting that they did not receive recommended care due to denials or delays caused by prior authorization. Furthermore, 69% of respondents reported experiencing anxiety, and 73% of those who experienced care delays endured delays lasting 2 weeks or longer.

The study also revealed the significant administrative burden placed on patients due to prior authorization. A majority of respondents described the prior authorization process as bad or horrible (40% and 32% respectively), highlighting the negative experiences patients encounter when navigating this system.

Thom explained that the study aimed to capture the patient voice and ensure it is included in conversations about prior authorization. While existing literature has focused on provider perceptions and lost productivity, this study sought to center the experiences of patients and highlight the harm caused by prior authorization.

Prior authorization can lead to delayed cancer diagnosis and treatment, as well as increased anxiety and decreased trust in the healthcare system and insurance companies. It places an additional burden on patients and their caregivers, who already face the challenges of managing cancer.

These findings underscore the pressing need to address the harms caused by prior authorization and find solutions. While complete elimination of prior authorization may not be feasible, raising awareness of the issue and working towards streamlining the process are important steps forward. Understanding the downstream effects of prior authorization on patients and investigating potential alternatives are crucial for improving cancer care and reducing patient suffering.