A recent nationwide survey has confirmed that prior authorization may cause treatment delays, abandoned treatments, hospitalizations, and deaths among patients with cancer, according to an executive summary published by the American Society for Radiation Oncology (ASTRO). The findings may reinforce the urgent need for Congress to pass legislation to reform prior authorization and prevent further harm to patients with cancer.
Background
Radiation oncologists face the greatest likelihood of any clinical specialty to encounter prior authorization. ASTRO members consistently rank prior authorization as the top issue facing their practices in yearly benchmarking surveys.
Survey Methods and Findings
In the survey, researchers asked more than 750 radiation oncologists to answer questions regarding prior authorization. The survey was conducted online in September and October 2024 and achieved a 16% response rate.
Nearly one-third (30%) of the radiation oncologists stated that prior authorization has caused emergency room visits, hospitalizations, or permanent disability in their patients. In addition, 7% of them noted the policy has led or contributed to a patient’s death.
The respondents detailed other ways in which prior authorization may undermine cancer outcomes. Nearly all of the radiation oncologists (92%) indicated that prior authorization causes treatment delays in their patients. Delays occur for an average of 35% of the patients. More than two-thirds of physicians said the average prior authorization delay for their patients lasted at least 5 days, up from about half (52%) reporting similarly long delays in ASTRO’s 2020 survey. Delays in the start of radiation therapy are associated with an increased risk of cancer progression, complications, and mortality.
In addition, one-third of the physicians detailed that prior authorization has led to their patients abandoning radiation treatment, with an average of approximately 10% of their patients leaving treatment. About 82% of physicians noted that prior authorization has forced them to resort to a less optimal treatment, and this has happened with greater frequency compared with in previous ASTRO surveys. Many radiation oncologists reported difficulty obtaining insurance approval for drugs needed for the effects of cancer treatment, including those for nausea (23% of the respondents), erectile dysfunction (18%), prescription skin care (17%), and pain (opiate = 40%, nonopiate = 10%).
The researchers also revealed that issues related to prior authorization may be worsening. For instance, patients are now experiencing longer radiation therapy delays compared with during the height of the COVID-19 pandemic.
The researchers found that 85% of the radiation oncologists reported that their burden increased in the past 3 years, and 94% of them stated that prior authorization worsened staff burnout in their cancer clinics. The respondents detailed other ways in which prior authorization policies have added to the strain on cancer providers and clinics. About 80% of them noted that prior authorization made it necessary to reallocate staff time to manage the prior authorization process at their clinic, and about 60% of them stated they had to hire additional staff as a result. A majority (54%) of the survey respondents said that more than 50% of their cases required prior authorization approval, up from 51% in 2020 and 44% in 2019. Radiation oncologists in 2024 estimated that 71% of their requests were initially approved. For those that were denied, ultimately 73% of the denials were overturned on appeal. Rates of initial approvals and overturned denials were both higher compared with previous ASTRO surveys. Just two-thirds of peer-to-peer consultations for radiation treatments were performed by radiation oncologists. Key issues with the process included insurance companies’ lack of transparency on the requirements for approval, peer reviewers not being able to make decisions, and scheduling inflexibility that added to patient delays.
Conclusions
ASTRO supports multiple policy solutions to address this flawed system, including legislation currently circulating in both chambers of Congress.
“These survey findings confirm what radiation oncologists witness daily: prior authorization policies are failing [patients] with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly,” emphasized Howard M. Sandler, MD, FASTRO, Chair of the Board of Directors at ASTRO. “The ASTRO-supported Improving Seniors’ Timely Access to Care Act of 2024 (S.4532, H.R.8702) would bring much-needed reform to prior authorization for Medicare Advantage plans, such as establishing a real-time process for coverage decisions. We encourage Congress to act now to help end these life-threatening delays and put Medicare Advantage on a path toward transparency and accountability by passing this legislation before the current session ends,” he concluded.
The bill currently has 228 House and 58 Senate cosponsors.
Disclosure: For full survey results, visit astro.org.
