Prior Authorization Process Leading to Delay in Critical Cancer Treatment for Consumers   

By Consumers for Quality Care, on January 17, 2024

Prior authorization for cancer treatment is leading to potentially deadly delays for consumers in need of critical care, according to KFF Health News. 

Florida resident Leslie Fisk was diagnosed with lung and brain cancer in 2021. After going through several rounds of chemotherapy, her doctors recommended radiation treatment for her lungs. Her private insurance company, Florida Health Care Plan, denied coverage, deeming it medically unnecessary. Fisk was eventually approved treatment after fighting Florida Health Care Plan “tooth and nail,” but called the whole ordeal “horribly traumatic.” KFF was unsuccessful in reaching Florida Health Care Plan for comment on why Fisk’s radiation treatment was initially denied.

Prior authorization is a cost-control measure that often delays patients’ access to care. Fumiko Chino, MD, is a radiation oncologist at Memorial Sloan Kettering Cancer Center in New Jersey and an expert in navigating the prior authorization process. She described the current process that insurers use for prior authorization as “denial by delay,” adding that just a two-week delay in treatment could be deadly for many patients. 

Chino’s research, published in the Journal of the American Medical Association, concluded that prior authorization is directly related to increased anxiety among cancer patients. In addition, a KFF report determined Medicaid consumers are more likely to be affected by prior authorization, with one in five adult consumers reporting they had been denied or had delayed treatments, doctor’s visits, or medication.  

Policymakers have started to take action to reduce prior authorization wait times and to require that insurers give consumers more detailed information about why a procedure or drug was denied. Until these reforms are fully implemented and enforced, consumers will still find themselves confronted with red tape. 

CQC urges lawmakers and providers to eliminate needless, burdensome processes that prevent consumers from receiving the medical care they need.