Bill aiming to reduce prior authorization delays for cancer treatment introduced in Congress

por John R. Fischer, Senior Reporter | June 07, 2019
Rad Oncology
A new bill aims to reduce prior
authorization delays to cancer
A group of U.S. representatives have introduced a new bill that proposes a plan for reducing obstacles to cancer care, including restrictive prior authorization practices.

Named The Improving Seniors’ Timely Access to Care Act of 2019, the bipartisan federal legislation aims to reform prior authorization to prevent unnecessary delays in patient access to critical cancer treatments, and enable radiation oncologists and other clinicians to use their clinical judgment to prescribe the best course of treatment for patients.

“There is legitimate concern that the administrative burdens associated with prior authorizations might sometimes result in physicians feeling forced to provide lower value care to avoid extra delays for approval of care that they believe to be more clearly in the patient’s best interest,” Brian D. Kavanagh, the immediate past chair for the ASTRO Board of Directors, told HCB News. “The physician is balancing what they believe to be the best possible, most personalized course of treatment against the patient’s mounting anxiety about delayed access to treatment. It is frustrating that the initial denials imposed by benefits managers often occur because they use guidelines that are outdated and lag behind currently accepted practice standards.”

More than nine out of 10 physicians experience delays in providing lifesaving treatments to their patients due to prior authorization, with one-third equating the average delay to longer than one week, according to a nationwide survey conducted by ASTRO. Each week of delay in starting cancer therapy causes a 1.2 to 3.2 percent increase in the likelihood of death, and adds stress and anxiety to patients who are already concerned about their health.

Doctors or staff members who object to these delays or denials can file appeals for review at a higher level within the Radiation Oncology Benefits Managers (ROBMs). Many, however, are often forced to consult with one or more individuals who may or may not have any training in oncology, while patients are left waiting, with no guarantees that they will receive treatment. This adds emotional distress and prolongs symptoms that can adversely impact their quality of life.

The new legislation seeks to increase transparency in the prior authorization process by making clear what the regulations of the ROBMs are to help clinicians in their decision-making. It also aims to reduce unnecessary delays for patients covered by Medicare Advantage plan by requiring the plans to relay relevant information, including annual disclosure of medical treatments subject to prior authorization; the percentage of requests that are approved and denied; and the average time for approval. In addition, it supports the use of an electronic prior authorization process to streamline decisions and avoid unnecessary delays for certain procedures.

“The best effects of the bill for patients would be to mandate speed and transparency on the part of the companies engaged in managing health insurance benefits for those suffering from cancer and other serious medical conditions,” said Kavanagh. “We hope some of the current built-in inefficiencies and delays with the current system can be eliminated so that patients can receive care in a timely manner without unnecessary added angst.”

The bill has been endorsed by several leading health providers, patient advocacy groups, and other organizations, and was introduced by Rep. Suzan DelBene (D-Wash.), Rep. Mike Kelly (R-Pa.), Rep. Roger Marshall, MD (R-Kan.) and Rep. Ami Bera, M.D. (D-Calif.).

“As a doctor, I’m proud to be co-sponsoring this long-needed legislation to help relieve administrative burdens on practicing physicians,” said Rep. Ami Bera in a statement. “Physicians spend far too much time on burdensome paperwork and seeking authorization on certain items, when they can be spending that time taking care of their patients. This bill modernizes the process, and is a win for physicians and patients.”

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