Restrictive prior authorization practices (view press kit)
While prior authorization was a major challenge for radiation oncology before the COVID-19 public health emergency, the burden has grown more difficult during the pandemic and physicians say they increasingly are constrained from exercising their clinical judgment in the best interest of their patients.
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In an August 2020 ASTRO survey of radiation oncologists, most respondents (69%) said the overall burden of prior authorization has gotten worse for their practice since the start of the pandemic and that patients face more treatment delays from prior authorization since the COVID-19 outbreak (64%). "The majority of patients are now delayed over two weeks for a fairly routine denial and appeal process," explained one survey respondent. "Virtually all appeals are successful, but in the meantime, we have upset patients, angry family members and an emotionally exhausted staff interacting on a daily basis."
Overall, 85% of the doctors said their patients express concerns about delays caused by prior authorization, and alarmingly, many also report that their patients have suffered adverse events (35%) or negative effects (66%) because of these delays. For example, one physician shared that a patient developed a brain metastasis while waiting for treatment to be approved by an insurer; this progression proved fatal as it led to the patient's untimely death.
"Many believe that prior authorization is a straightforward process that reduces health care costs. This simply is not the case, however. Without extensive reform to bring much-needed transparency, consistency and integrity to the prior authorization process, these restrictive and unnecessary practices will continue to hijack medical decisions and cause harm to patients," said Dr. Eichler.
While ASTRO and other leading medical groups have strongly urged insurance and radiation oncology benefit management companies for several years to address the broken prior authorization system, the problem is getting worse. Accordingly, radiation oncologists are asking lawmakers to join the bipartisan cosponsors of the Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107), which would increase transparency in the prior authorization process and help curb delays for patients covered by Medicare Advantage plans.
Investment in cancer research (view infographic)
Federal investment in cancer research has played a role in every major innovation in the fight against cancer and has led to a decline in mortality rates for many cancers. The American Cancer Society (ACS) estimates, for example, that research has contributed to averting 2.9 million cancer deaths in the U.S. in the past two decades.