How cancer patients view prior authorization

November 2, 2023

Source: JAMA Network Open, October, 2023 LINK

Health policy research often uses claims data to assess impact of health policy decisions. Researchers less frequently ask patients about their experiences, which can mean that health policy is insufficiently patient-centric. Researchers from Memorial Sloan Kettering Cancer Center (New York City) recruited 178 cancer patients who reported experience with prior authorization to assess their experience. They recruited patients through social media, so this was by no means a representative sample. Many cancer patients might have been subject to effective prior authorization and never even known about it, and they would not have been recruited for these interviews.

Those surveyed were overwhelmingly women (88%) and non-Hispanic White (84%), and they reported severe friction with prior authorization. A fifth (21%) reported that they had not received recommended care due to insurance company review, and two thirds (69%) reported a delay of care. Three quarters (72%) of those with delays reported that their delay was over two weeks. Eighty nine percent said the prior authorization process decreased their trust in their insurance company, and 83% said it decreased their trust in the health care system.

This non-representative survey overstates how much friction and harm is done by prior authorization programs because it selectively recruited those who felt aggrieved. Still, this reminds us that utilization management programs can interfere with patient experience and can degrade patient care. The loss of trust in the health care system in this study is especially worrisome.

Implications for employers:

-        Employers should be sure that their carriers implement prior authorization programs thoughtfully.

-        Prior authorization programs can exempt providers who have few or no denials and collect information directly from electronic health records to allow rapid decision-making.

-        Carriers should expedite appeals for those being treated for cancer, where the emotional toll of an unnecessary wait is especially high.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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