Prior Authorization Has Negative Impact on Cancer Patients’ Well-Being

Prior authorization requirements are associated with delays or changes in cancer treatment that negatively impact patients’ well-being and perceptions of the health care system, according to research published in JAMA Network Open.

The study showed that prior authorization requirements can prevent patients from receiving recommended care, delay care, increase patient anxiety and administrative burden, and cause patients to lose trust in their insurance company and the health care system overall.

For this study, researchers surveyed 178 cancer patients who had experience with prior authorization. The most common diagnoses were breast cancer (44%), hematologic malignancies (12%), and lung cancer (11%).

Most patients (84%) had private insurance, but 9% had Medicare, and 7% had Medicaid. Prior authorization was most often needed for imaging (71%), intravenous chemotherapy (49%), surgery (47%), and radiotherapy (34%).

Most patients (63%) had the recommended care approved and did receive it, but 22% did not receive recommended care, and 10% only received recommended care because they paid out of pocket.

Of the patients who did not receive recommended care, 67% had prior authorization denied, and 33% experienced delays that required them to receive different treatment. Of the patients who paid out of pocket, 53% said they received a “surprise” bill.

Overall, 69% of patients reported a delay in care due to prior authorization. Of those patients, 73% reported a delay of at least 2 weeks, and 33% reported a delay of at least 1 month.

A majority of patients (67%) said they became personally involved in the prior authorization process, and 20% of these patients said this involvement required at least 11 hours of their time.

The prior authorization experience was rated as “bad” by 40% of patients and “horrible” by 32%. Worse ratings were significantly associated with the length of delay in care (P <.001) and the amount of time dedicated to the prior authorization process (P <.001).

The prior authorization process was associated with higher than normal levels of anxiety in patients (P <.001). Prior authorization-related anxiety was associated with the length of delay (P =.04), the amount of time spent on prior authorization (P <.001), and the patient’s overall experience with prior authorization (P <.001).

Prior authorization was associated with decreased trust in the patient’s insurance company among 89% of patients and with decreased trust in the health care system in 83%.

“This study suggests that PA [prior authorization] for cancer care can have discrete negative associations with outcomes for patients; streamlining the process is key to optimizing the quality of care delivered and improving the patient experience with cancer care,” the researchers concluded.

Disclosures: Some study authors declared affiliations with insurance, biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Chino F, Baez A, Elkins IB, Aviki EM, Ghazal LV, Thom B. The patient experience of prior authorization for cancer care. JAMA Netw Open. Published online October 18, 2023. doi:10.1001/jamanetworkopen.2023.38182

This article originally appeared on Cancer Therapy Advisor