Year: 2025
Type: conference-abstract
Abstract: 177 Background: Prior authorization (PA) is an insurance-mandated utilization strategy and may result in delayed or denied care. PA burden has increased over time, with both patient and providers noting negative impact on efficiency and outcomes. We sought to better understand the current landscape of PA at a large academic cancer center, in order to identify areas of need and potential improvement. Methods: We analyzed all PA requests for outpatient prescriptions at the specialty pharmacy of a quaternary referral cancer center from 1/1/2024-12/31/2024. Descriptive statistics determined time to resolution (TTR) and final disposition (i.e., approved versus denied). PAs with incomplete, pending, or cancelled status were excluded from TTR evaluation. Final disposition was categorized as approved, denied, or cancelled (with cancelled requests excluded from final denial rate calculations). Specific prescription type (i.e. anticancer, supportive care) was evaluated; the largest subgroups were also evaluated. Results: A total of 5944 PAs were initiated in 2024. Of these, 5249 (88%) were anticancer drugs and 695 (12%) were supportive. Of anticancer drugs, 705 (13%) were drugs with generic formulations available. The most common supportive meds were: 234 (34%) pain,106 (15%) anti-emetic, 64 (9%) neutropenic prophylaxis, 56 (8%) antimicrobials, and 54 (8%) dermatologic/rheumatologic. The median TTR for all PAs was 1.3 days (Interquartile range, IQR 2.5) and consistent across all prescription types. Maximum TTR was 60.3 days overall but this was driven by supportive care (and more specifically pain meds). Maximum TTR for all other supportive meds was 35.4 days and 35.2 days anti-cancer drugs. Overall, 16% of PAs were denied, including 15% of anticancer drugs and 22% of supportive drugs. Subgroup denial rates are listed in Table 1. Conclusions: In this landscape analysis of 1 year of prior authorization at a specialty pharmacy of large cancer center, over 100 PA were required per week and 1 in 6 prescriptions were ultimately denied. These outcomes likely represent the idealized situation given data comes from a well-funded/highly resourced cancer center with trained staff dedicated to the PA process and patients with excellent insurance coverage and high socioeconomic status. National efforts to reduce PA burden are needed. Prior authorization outcomes by prescription type. Total (n) Median TTR (days) IQR TTR (days) Max TTR (days) Approved (n) Denied (n) Denial Rate (%) All 5944 1.3 2.5 60.3 4530 833 16 Anti-Cancer 5249 1.3 2.5 35.2 4134 720 15 Generic Available 705 1.3 3.4 28.2 562 0 0 Brand Name Only 4544 1.3 2.5 35.2 3572 720 16 Supportive 695 1.3 2.5 60.3 397 113 22 Pain 234 1.2 2.6 60.3 144 30 17 Anti-Emetic 106 0.4 1.1 14.3 76 6 7 Neutropenia Prophylaxis 64 1.3 3.4 35.3 35 15 30
Source: JCO Oncology Practice
Authors: Sharjeel Syed, John Kent Lin, Fumiko Chino
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4414893369