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Prior authorization in gynecologic oncology: An analysis of clinical impact

  • Anna Jo Bodurtha Smith
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States of America.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
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  • Lakeisha Mulugeta-Gordon
    Affiliations
    Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
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  • Daniella Pena
    Affiliations
    Cornell University, Ithaca, NY, United States of America
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  • Genevieve P. Kanter
    Affiliations
    Department of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Department of Medical Ethics and Health Policy, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
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  • Justin E. Bekelman
    Affiliations
    Department of Radiation Oncology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
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  • Author Footnotes
    1 Present address for Dr. Haggerty: Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey.
    Ashley E. Haggerty
    Footnotes
    1 Present address for Dr. Haggerty: Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
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  • Emily M. Ko
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America

    Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America
    Search for articles by this author
  • Author Footnotes
    1 Present address for Dr. Haggerty: Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey.
Published:October 13, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.10.002

      Highlights

      • 1 in 4 patients experience prior authorization during gynecologic oncology care.
      • Imaging accounted for 54% of prior authorization followed by supportive medications (29%) and chemotherapy (17%).
      • 79% of prior authorizations were approved with a 2-week care delay on average.

      Abstract

      Background

      Prior authorization was designed to minimize unnecessary care and reduce spending but has been associated with delays in necessary care. Our objective was to estimate the occurrence of prior authorization, and impact on cancer care, in gynecologic oncology.

      Methods

      We performed a retrospective cross-sectional study of patients seen in University of Pennsylvania gynecologic oncology practices (January–March 2021). Using electronic medical records, we measured the incidence of prior authorization during the 3-month period and prior experience of prior authorization for cancer care overall and by type of order (chemotherapy, imaging, surgery, prescription drugs). We assessed the impact of prior authorization occurrence on clinical outcomes (time to service, changes in care).

      Results

      Of the 2112 clinic visits of 1406 unique patients, 5% experienced prior authorization during the 3-month study period. An additional 20% faced prior authorization requests earlier in cancer care. Of the 83 prior authorization requests, imaging accounted for the majority (54%) followed by supportive medications (29%) and chemotherapy (17%). After appeal, 79% of cases were approved. For patients whose prior authorizations were approved, there was a mean of 16 days from order placement to care delivery (95% CI 11–20, range 0–98 days). Of the 17 denials, 3 (18%) led to a substantial change in care (i.e., not receiving planned treatment).

      Conclusion

      25% of gynecologic oncology patients experienced prior authorization during their cancer care. While 80% of claims were ultimately approved, patients experienced over a 2-week delay in care when prior authorization occurred. Reform is needed to reduce the burden of prior authorization in oncology.

      Keywords

      Abbreviations:

      AMA (American Medical Association)
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