Note: Responses were lightly edited for style.
Question: How do traditional prior authorization processes negatively impact patients and practices?
1. For patients: treatment delays. It’s gut-wrenching for patients and their families to have to wait for an insurance company to decide whether it will or will not cover a test the doctor believes might help choose a treatment.
2. For patients: wrong treatment decisions. Traditional PA doesn’t provide true decision support. So, while it might reduce the testing that occurs, it might also prevent the doctor from testing appropriately and consequently finding the right treatment.
3. For practices: burden and cost. A recent American Society of Clinical Oncology study cited the impact that prior authorization has on practices. Oncology groups have to maintain teams of people who do nothing but obtain prior authorization, and that is just for the use of drugs. If we add the requirement to PA every test, it places too much burden on the practice in terms of time and cost.
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