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:
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Article info
Publication history
Published online: October 13, 2022
Accepted:
October 1,
2022
Received in revised form:
September 25,
2022
Received:
June 28,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
