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February 5, 2024
3 minutes of reading
According to study results, more than one in five people with cancer did not receive doctor-recommended care due to prior authorization requirements.
Prior authorization also led to delays in care — many lasting two weeks or more — as well as increased patient anxiety and administrative burden, results from a cross-sectional survey-based study showed.
“This study was motivated by the experiences of physicians and patient advocates on our research team, all of whom felt that the patient voice was being left out of conversations about prior authorization“, investigator Bridgette Thom, PhD, the senior research specialist at Memorial Sloan Kettering Cancer Center told Healio.
“To date, most of the existing literature focuses on supplier perceptions and productivity loss,” Thom added. “While these studies and analyzes are important to take a broader view of the harms of prior authorization, our team felt it was necessary to center the patient voice.”
Thom and colleagues surveyed 178 people with cancer (88% women; 84% non-Hispanic white; 92% under age 65) to learn their perspective on the impact of prior authorization on cancer care.
Results showed that 22% of patients who responded to the survey did not receive recommended care due to denials or delays. More than two-thirds (69%) of respondents reported delays in care due to prior authorizationand three-quarters (73%) of those who experienced delays in care experienced delays of 2 weeks or more.
The results also showed a high administrative burden for patients due to prior authorization.
Most respondents characterized the prior authorization process as bad (40%) or horrible (32%).
Healio spoke to Thom about the findings and their potential implications.
Healio: Why? Did you focus on patient perspectives regarding prior authorization?
Tom: This centering allows us to share the experience of anxiety and fear related to delays in diagnosis and the suffering felt when supportive medications and other treatments are delayed.
Healio: Can you tell us more about how you conducted the study and the main results of interest?
Tom: We developed and tested survey questions with our patient advocate. Main outcomes included prior authorization outcomes, such as approvals/denials and delays, self-reported patient anxiety, patient confidence, and patient administrative burden, which refers to how much time and effort patients spent dealing with prior authorization.
We recruited study participants using social media and email lists of cancer advocacy organizations, and participants completed the survey online. Patients were also able to respond to an open-ended question that allowed them to share their experiences in their own words.
Healio: What did you find?
Tom: Given our recruitment methods, we were likely to end up with a sample enriched with patients with negative experiences, and indeed the findings were compelling. More than two-thirds experienced some type of delay in their care due to prior authorizations, and 73% of these delays exceeded two weeks. In 63% of cases, recommended care was ultimately provided. Prior authorization led to increased anxiety among respondents, as well as decreased trust in both the healthcare system and insurance companies.
Sixty-seven percent of respondents had to be personally involved in the process and 20% spent more than 11 hours processing prior authorization. It is important to consider the context, as these delays and efforts by patients and their caregivers occur in the midst of cancer diagnosis and treatment.
Healio: Most surveys Respondents rated the prior authorization experience as bad or horrible. What are the implications of this finding?
Tom: At the most basic level, these findings shed light on the harms experienced by patients. For starters, your care and medications are being delayed. So not only do patients have to take time out of their day (while going through treatment) to manage the multiple stakeholders involved in the prior authorization process, but they also experience anxiety about the process. They don’t know if their care will be covered, and if it isn’t covered, they don’t know if they will be able to pay for it.
Healio: Do these findings reveal a potential danger? Of delay in cancer care due to prior authorization?
Tom: There is definitely a danger sign, particularly related to potential delays in diagnosis, necessary imaging, and symptom management. For example, managing cancer-related symptoms often focuses on relieving pain and nausea. Patients who experience delays in receiving these medications may have to turn to more expensive alternatives, including emergency department visits or urgent care visits, to manage their symptoms. We are working on research to understand the downstream effects of prior authorization on patients.
Healio: What are the possible solutions?
Tom: In a perfect world, there would be no prior authorization in the acute illness setting: Payers could simply allow providers to make decisions about their patients’ treatment. In reality, a number of actions are needed to address the situation. One is awareness of the problem. Our study is a good first step to focus the patient perspective to learn first-hand the physical and psychosocial impacts of insurance companies’ business strategies in real life. Future patient-centered research, with a more diverse sample than our study, is needed to quantify and characterize the downstream consequences of prior authorization. Political efforts are also needed to increase the transparency of prior authorization and the timeliness of decisions.
Reference:
For more information:
Bridgette Thom, PhD, You may contact Memorial Sloan Kettering Cancer Center, 321 E. 61st St., Office 416, New York, NY 10065; email: bridgette.thom@unc.edu.
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Disclosures: Thom does not report any relevant financial disclosures. He consults the study for relevant financial disclosures from all other authors.
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