A new study reveals the unseen suffering and danger caused by insurance prior authorization requirements for cancer patients across America. Researchers at Memorial Sloan Kettering Cancer Center surveyed 178 cancer patients on their experiences with prior authorization and uncovered sobering results.
Over one in five patients reported not receiving clinician-recommended care due to prior authorization denials or delays. Nearly 70% experienced delays in care, with over 70% of those facing delays of two weeks or longer. This resulted in increased anxiety, decreased trust in healthcare, and unnecessary administrative burdens for already vulnerable patients.
As lead author Dr. Bridgette Thom explained, this study aimed to capture the overlooked patient perspective missing from most prior authorization research. While past analyses focused on provider burdens, her team felt it was vital to spotlight the patient voice. Their survey results now provide stark insights into the human impacts of prior authorization policies.
Denied or Delayed: The Physical and Emotional Toll
Receiving prompt, clinician-recommended care matters greatly for cancer patients. Disease progression waits for no one, and delays can allow cancers to spread, symptoms to worsen, and outcomes to decline. For patients already facing a life-threatening illness, having treatment denied or postponed can heighten fears of mortality.
Over 20% of surveyed patients reported not receiving recommended care due to prior authorization roadblocks. Cancer treatments, tests, and medications were all affected. These denials can force impossible choices onto vulnerable patients. As one respondent shared: “I had to decide between surveillance and treatment. We opted for treatment. It was stressful because if we didn’t do treatment, it may have gotten worse.”
Delays were even more pervasive, reported by nearly 70% of patients surveyed. Disturbingly, over 70% of these delays spanned two weeks or longer. As any oncologist will attest, waiting weeks to begin urgently needed cancer treatment or testing can negatively impact prognosis and survival. As one patient stated: “Making a patient wait for life-saving medication for 3 weeks is unconscionable.”
These delays also take a serious psychological toll, provoking anxiety in an already frightening time. Patients shared feeling “terrified” and “stressed to the max” when treatment was postponed for prior authorization reasons. As cancer spreads unchecked, fears of mortality understandably rise. Delays also erode patient trust in the healthcare system and insurance providers.
Hours Spent on Phones and Paperwork: The Caregiver Burden
In addition to clinical impacts, prior authorization burdens patients with significant administrative tasks at the worst possible time. Over 60% of surveyed patients spent hours battling insurance denials and delays themselves. 20% spent over 11 hours on prior authorization duties amidst their cancer care.
As one respondent shared: “I have had to become my own unpaid insurance case manager.” Patients described spending hours repeatedly calling insurance companies and submitting appeals. They had to coordinate between providers and insurers, gather clinical documentation, and argue their case. As active cancer treatment drained their energy, prior authorization sapped even more.
For the 40% of patients too ill to self-advocate, caregiver duties increased dramatically. As one caregiver shared: “It caused me countless hours on the phone…when I should have been by my dying sister’s side.” Caregivers expressed outrage at needing to fight for patient care while providing emotional support.
Potentially Deadly Danger Signals
These survey results raise serious concerns about the downstream effects of treatment delays on cancer outcomes. As Dr. Thom explained, there are dangerous signals around diagnostic and symptomatic delays. Postponing diagnostic tests could delay cancer detection until later, harder-to-treat stages. Delaying medications for cancer pain, nausea, or other symptoms can force patients into costlier ER visits to manage them.
There are also warnings around denied medications and treatments. For example, many effective and affordable older cancer drugs are blocked by insurers in favor of newer, more expensive alternatives. Yet the older drugs may be better proven and tolerated by individual patients. Denying patient-specific drug choices can negatively impact adherence, efficacy, side effects, and overall outcomes.
Can Policy Changes Bring Relief?
In response to these stark findings, the study authors and other experts suggest policy changes to ease prior authorization burdens. First, greater transparency around denial rates and delays could spotlight problematic insurers and treatments. Second, enforcing stricter turnaround timelines could prevent harmful delays. But the clearest solution may be eliminating prior authorization for established, guideline-based cancer care altogether. With providers already following evidence-based protocols, extra insurance hurdles offer little clinical benefit to justify their harms.
As oncologist Dr. Yousuf Zafar commented: “Prior authorization in cancer care has little medical basis. Experts decide treatments, not insurers. Reducing this barrier can help patients start care promptly.” More research into downstream outcomes, plus policy reform, offer hope of progress for cancer patients worn down by prior authorization burdens.
In the words of one disheartened patient: “Going through the diagnosis and treatment of cancer…is bad enough. The stress of dealing with payment concerns can sometimes feel life-threatening in itself.” By spotlighting the overlooked patient experience, studies like this one bring us one step closer to reducing the needless suffering caused by prior authorization in cancer care.