Although the process of obtaining insurance prior authorization before a patient’s medical procedure, service, or prescription has typically been left to clinicians, as cancer therapies grow increasingly complex, the burden of navigating prior authorization is increasingly being shared by patients and their families.
The results from a survey asking adults with cancer to evaluate their experience with prior authorization show that half of the respondents reported direct involvement in the process, often facing substantial time burdens. Men, younger patients with employer plans, and those with advanced disease more commonly faced care delays and insurance-related hardship. The study will be presented by Zaleta et al during the 2025 ASCO Quality Care Symposium, taking place October 10 to 11 in Chicago and online (Abstract 175).
Study Methodology
The researchers recruited adults with cancer from national survey panels for an online survey to evaluate patients’ prior authorization experiences. The survey was conducted between September and December 2024. Eligibility for the survey included being age 26 or older, having employer- or Medicare-provided insurance coverage, and receiving treatment for cancer in the past 12 months.
Survey respondents were asked to report on whether they underwent prior authorization for each treatment type they received between 2022 and 2024, and then answered questions about their most recent experience with prior authorization. The researchers examined bivariate differences between prior authorization involvement with patients’ sociodemographic background, clinical history, and insurance-related impacts using T- and Chi-Squared (X2) tests. They then estimated a multivariable logistic regression model predicting the likelihood of patient involvement by correlates significant at the bivariate level.
More than half of the survey respondents were women (59%); the mean age was 53 years; 71% were non-Hispanic White, 13% were non-Hispanic Black, and 11% were Hispanic. The main cancer diagnoses included breast (32%), prostate (12%) and hematologic (11%) cancers. The respondents were a median of 2 years from diagnosis. The most common types of treatment received included radiation therapy (71%), intravenous chemotherapy (65%), and immunotherapy (63%). The most common type of insurance was employer-based (55%), followed by Medicare Advantage (31%), and traditional Medicare (14%).
Results
The researchers found that of the 1,201 eligible respondents who completed the survey, 890 (74%) had dealt in some way with prior authorization. Half of the respondents (50%; n = 444) reported direct involvement by self/family in their most recent prior authorization experience. The remainder (n = 446) reported that their health-care team fully handled their prior authorization.
Among those involved in obtaining prior authorization, 50% reported spending up to 1 business day (1–8 hours), 29% spent 2 to 3 business days (9–24 hours), and 12% spent a full business week or more (41+ hours) on obtaining a single incidence of prior authorization.
Involvement differed for certain types of treatment, including targeted therapy (73% personally involved vs 27% handled completely by the health-care team), supportive medications (64% vs 36%), radiation (40% vs 60%), and imaging (40% vs 60%) at the bivariate level.
Multivariable regression confirmed significantly greater odds of involvement for those aged < 65 years with employer plans (odds ratio [OR] = 3.70) and those aged < 65 years on Medicare (OR = 2.06), compared with those aged ≥ 65 years on Medicare. For men (OR = 2.12), patients with advanced disease (OR = 2.06), and those with delays in diagnosis (OR = 1.66) or treatment (OR = 1.54) due to prior authorization, greater negative insurance-related impacts included physical, emotional, and financial well-being (OR = 1.23) and greater cost-related medication expenditure (OR = 1.21).
“Many people with cancer get directly involved in prior authorization, often facing substantial time burdens. Involvement was most common among younger patients with employer plans and those with advanced disease, and associated with care delays and insurance-related hardship. There is an urgent need for prior authorization reform to reduce burden and ensure timely, equitable access to cancer care,” concluded the study authors.
The Burden of Prior Authorization on Patients
“This study highlights how cancer patients and their families are being pulled into the insurance prior authorization process, at the expense of their time, health, and well-being,” said Alexandra Zaleta, PhD, lead author of this study and Vice President, Research and Insights at CancerCare. “While doctors and care teams often take the lead, half of patients told us they also had to roll up their sleeves by personally making calls, filing paperwork, or chasing down approvals. Many lost days, and some lost a full week or more, just to a single instance of trying to get approval for the care their doctors had already prescribed. By documenting the scale of this hidden burden, our research shows that prior authorization is not just an administrative step—it’s a serious barrier to quality care.”
ASCO Expert Perspective
“This study makes clear what many of us in oncology have suspected: Prior authorization isn’t just an administrative hurdle for clinicians; it’s a hidden second job for patients,” said Marcin Chwistek, MD, FAAHPM, Director, Supportive Oncology and Palliative Care Program at Fox Chase Cancer Center and an ASCO expert in palliative care. “This study found that patients with cancer, particularly younger patients and those with advanced disease, often have to personally navigate the authorization process, leading to delays in treatment and financial and emotional strain.”
Disclosures: Funding for this study was provided by AstraZeneca, Bristol Myers Squibb, Exelixis, GSK, Lilly, Merck, Pfizer, and Regeneron. For full disclosures of the study authors, visit coi.asco.org.
