Three new studies highlighted the growing burden of prior authorization on both oncologists and patients.

Findings from a survey of radiation oncologists, for instance, revealed that more than 80% reported an increase in prior authorizations over the past 3 years, and almost all reported prior authorization-related treatment delays, many of which led to serious consequences for patients.

The two other analyses explored the burden prior authorization puts on patients with cancer. One found, for instance, that those with cancer spent anywhere from 1 business day to over 1 business week (more than 41 hours) addressing prior authorization hurdles, which often caused delays in care, stress, and time away from work.

This time burden “study makes clear what many of us in oncology have suspected: Prior authorization isn’t just an administrative hurdle for clinicians, it’s a hidden second job for patients,” Marcin Chwistek, MD, FAAHPM, director of Supportive Oncology and Palliative Care Program at Fox Chase Cancer Center in Philadelphia, said in a press release.

The studies were presented at the American Society of Clinical Oncology Quality Care Symposium in Chicago this week.

Time Wasted, Care Delayed

The time burden analysis highlighted the extent of patients’ involvement in prior authorization.

Researchers surveyed 1201 adults with cancer in the fall of 2024. Among the respondents, 74% (n = 890) said they had needed at least one prior authorization for a cancer treatment between 2022 and 2024, with nearly all experiencing prior authorization numerous times. Overall, half of the respondents said that they or their family had been directly involved in their most recent prior authorization, while the other half said prior authorization was handled by their healthcare team.

Among those with direct involvement, 50% said they spent up to 8 hours on one prior authorization issue, a third said they spent 2-3 days, while 12% spent a full business week or more.

Involvement varied by cancer treatment — 73% of those receiving targeted therapy, 64% of those on supportive medications, and 40% of those receiving radiation reported being directly involved in the prior authorization process. The researchers also found that prior authorization was happening before imaging and biomarker testing as well.

“There’s no therapy or intervention that’s being spared from this process,” lead investigator Alexandra Zaleta, PhD, vice president of Research and Insights at the national nonprofit CancerCare, New York City, told Medscape Medical News.

People more likely to be involved in handling prior authorization adults younger than 65 years on an employer plan (odds ratio [OR], 3.7) or on Medicare (OR, 2.06) than those aged 65 years or older on a Medicare plan. Others more likely to be involved were men (OR, 2.12), those with more advanced disease (OR, 2.06), those experiencing delays in diagnosis (OR, 1.66) or treatment (OR, 1.54), and those who scrimped on medication for cost reasons (OR, 1.21).

“The ones that are rolling up their sleeves tend to be sicker and are reporting worse barriers and worse outcomes,” Zaleta said.

Although most patients ultimately received coverage, the approvals came after much time spent documenting, appealing, and waiting — in other words, “only after people are experiencing all these negative impacts,” Zaleta said. “That’s a really hard pill to swallow.”

In another analysis, researchers highlighted the prior authorization issues surrounding supportive care medication access.

The research team analyzed prior authorization requests for outpatient long-acting opioids, non-opioid pain medications (such as pregabalin), and anti-nausea prescriptions over the first 9 months of 2024. During that period, 897 patients had a prior authorization for these medications, primarily for opioids (n = 714).

The researchers found prior authorization typically led to brief delays (0-2 days) with high authorization rates. But 6% of requests were denied, with a median of 7 days for those denials.

Overall, these patients “represent a vulnerable population,” with up to 1 in 5 patients hospitalized and 1 in 6 dying within 90 days of a prior authorization request, the authors explained. Additionally, 25% of patients went to a symptom care clinic and slightly fewer visited an urgent care center during that 90-day period.

Opioid delays had the greatest impact. Almost a quarter of those with prior authorization for opioids were hospitalized within 90 days compared with 13% of those with a prior authorization for non-opioids and 14% for anti-nausea medications.

But patients are not the only ones feeling the prior authorization strain. A survey found that radiation oncologists were experiencing a growing burden as well.

Despite a low response rate from the members of the American Society for Radiation Oncology (16%), 83% of those who did respond reported an increase in prior authorization over the past 3 years. Half said that more than 50% of cases required prior authorization, with a median approval rate of 75% and overturn rate of 82% for denials. However, for more than half of the cases, 43% of physicians said peer to peer “was a futile effort to overturn” prior authorization denials.

Three quarters of the clinicians said they had to reallocate staff to handle prior authorization, and 91% reported worse burnout related to prior authorization.

Prior authorization had negative impacts on patients as well. Almost all respondents said prior authorization resulted in treatment delays, and many (81%) said they sometimes had to use radiation techniques they considered less optimal.

Notably, one third of respondents reported that prior authorization led to serious complications for patients, including 7% who said prior authorization contributed to a patient’s death.

“By documenting the scale of this hidden burden, our research shows that prior authorization is not just an administrative step ⁠— it’s a serious barrier to quality care,” Zaleta said. “The time for reforming this is now,” she added.

The CancerCare Red Tape report, which contributed to the time burden analysis, is a project supported by grants from AstraZeneca, Bristol Myers Squibb, Exelixis, GSK, Lilly, Merck, Pfizer, and Regeneron. CancerCare reported owning the data and the analysis being independent. The Memorial Sloan Kettering study was supported by an MSK grant, a National Cancer Institute Cancer Center Support Grant, and a PSRP Developmental Funds Award.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.