Prior Authorization Delays Cause Serious Harm to Patients With Cancer

A new survey by the American Society for Radiation Oncology (ASTRO) confirmed that delays in prior authorizations cause significant harm to patients with cancer, leading to treatment delays, abandoned treatments, hospitalizations, and even deaths.¹

Insurance hurdles worsen delays, force abandoned treatments, and result in hospitalizations and deaths, radiation oncologists report nationwide. | Image credit: Maksim Shchur - stock.adobe.com

“These survey findings confirm what radiation oncologists witness daily: prior authorization policies are failing people with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly,” said Howard M. Sandler, MD, FASTRO, chair of the ASTRO board of directors, in a statement.

More than 1 million people in the US receive radiation therapy each year to treat cancer and other diseases, but restrictive prior authorization practices are creating significant challenges for patients and clinics.² In the latest ASTRO survey, conducted in the fall of 2024, more than 750 physicians from across the US shared their experiences, representing academic (47%) and private (51%) practices in diverse communities, including urban (49%), suburban (39%), and rural (13%) areas.

The online survey was sent to 4601 radiation oncologists in the US, with 754 respondents.

The findings reveal that restrictive prior authorization policies are not only harming people with cancer but also intensifying the strain on clinic staff, with the problem worsening in recent years.

Nearly a third (30%) of radiation oncologists reported that prior authorization has caused emergency department visits, hospitalization, or permanent disability for their patients, and 7% said it has led to or contributed to a patient’s death.¹ Widespread delays were also common, with nearly all respondents (92%) indicating that prior authorization causes treatment delays for their patients, affecting more than a third (35%) on average.

Alarmingly, more than two-thirds (68%) reported that these delays last 5 days or longer, a significant increase from 52% in 2020, with such delays linked to higher risks of cancer progression, complications, and death.

Additionally, one-third of physicians (33%) said prior authorization has led to patients abandoning radiation treatment, with 1 in 10 patients on average discontinuing care. More than 8 in 10 doctors (82%) said they were forced to resort to less optimal treatments more frequently than in prior surveys. Barriers extend to obtaining medications critical for managing the adverse effects of cancer treatment, with issues reported for nausea drugs (23%), erectile dysfunction aids (18%), prescription skincare (17%), and pain management medications (40% for opiates and 10% for nonopiate pain relief).

Radiation oncologists overwhelmingly noted that the burden of prior authorization has worsened, with 85% reporting an increase in the past 3 years. Nearly all (94%) said it exacerbates staff burnout, while 80% had to reallocate staff time to manage the process, and 60% needed to hire additional staff. The majority (54%) reported that more than half of their cases require prior authorization, up from 44% in 2019. While 71% of requests are initially approved, 73% of denied cases are overturned on appeal, illustrating inefficiencies in the process. Concerns about peer reviews also persist, as only 66% of peer-to-peer consultations are conducted by radiation oncologists, with systemic flaws such as a lack of transparency, decision-making authority, and inflexible scheduling further delaying patient care.

“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,” said Sandler, in a statement. “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.”

References

1. New ASTRO survey finds that prior authorization delays lead to serious harm for people with cancer. ASTRO. News release. December 3, 2024. Accessed December 4, 2024. https://www.newswise.com/articles/new-astro-survey-finds-that-prior-authorization-delays-lead-to-serious-harm-for-people-with-cancer

2. How prior authorizations harm cancer care. ASTRO. December 3, 2024. Accessed December 4, 2024. https://www.astro.org/ASTRO/media/ASTRO/News%20and%20Publications/PDFs/PriorAuthSurvey_2024ExecutiveSummary.pdf