October 20, 2021 — On behalf of the nation's radiation oncologists and the more than one million people with cancer they will treat this year, the American Society for Radiation Oncology (ASTRO) expressed strong support for today's Senate introduction of bipartisan federal legislation that would rein in restrictive prior authorization practices that delay patient access to critical cancer treatments.
The Improving Seniors' Timely Access to Care Act of 2021 was introduced in the Senate (S. 3018) today by Senators Roger Marshall, M.D. (R-Kan.), Kyrsten Sinema (D-Ariz.), John Thune (R-S.D.) and Sherrod Brown (D-Ohio). It was introduced in the House (H.R. 3173) on May 13 by Representatives Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, M.D. (D-Calif.) and Larry Bucshon, M.D. (R-Ind.) and is co-sponsored by 234 representatives — more than half of the House.
"Unnecessarily obstructive prior authorization practices can lead to potentially life-threatening delays in cancer treatment, and these delays increased during the COVID-19 public health emergency," said Thomas J. Eichler, M.D,. FASTRO, Chair of the ASTRO Board of Directors. "Prior authorization is not achieving its intended goal of improving efficiency and quality in American health care. Instead, the broken system causes our patients immense anxiety, undermines physicians' clinical judgment and drains resources from clinics struggling to recover from the pandemic."
"Legislation is an essential step to reform the prior authorization system, and we applaud Senators Marshall, Sinema, Thune and Brown and Representatives DelBene, Kelly, Bera and Bucshon for their bipartisan leadership on this critical issue," said Eichler. If passed, the bills would bring critical transparency and oversight to the prior authorization process and help curb delays for people covered by the Medicare Advantage program, including those receiving radiation treatments for cancer.
In an August 2020 ASTRO survey of radiation oncology practice leaders, more than two-thirds of respondents (69%) said the burdens of prior authorization have increased during the pandemic. Most physicians (64%) said cancer treatment delays due to prior authorization have increased, and more than half (52%) said the average delay lasts at least one week. Previous research has found that each week of delay in starting cancer therapy is associated with a 1.2% to 3.2% increased risk of death.
A separate study published earlier this year in JAMA Health Forum found that radiation oncology faces the highest prior authorization burden of any medical specialty: 97% of radiation oncologists perform medical services that are subject to prior authorization under Medicare Advantage plans, compared to 55% of clinicians averaged across medical specialties.
"The majority of patients are now delayed over two weeks for a fairly routine denial and appeal process," wrote one respondent to the ASTRO survey. "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." In a previous ASTRO survey, more than nine in 10 radiation oncologists said that their patients experience cancer treatment delays caused by prior authorization.
More than one-third of the radiation oncologists (35%) said their patients suffered adverse events due to delays caused by prior authorization during the pandemic. One physician, for example, shared that a patient developed a brain metastasis while waiting for treatment approval by an insurer; this progression proved fatal and led to the patient's untimely death.
The harmful effects of prior authorization may be worse for patients in smaller, more rural communities. Radiation oncologists outside of metro areas said that 9% of their patients stopped cancer treatment due to prior authorization delays, on average, compared to 7% of patients in smaller metro areas and 4% in major metro areas.
The findings from ASTRO's physician surveys align with reports from the American Medical Association (AMA) and American Cancer Society that demonstrate the pervasiveness of prior authorization obstacles throughout the health care system and the need for legislation to address the problem. Accordingly, radiation oncologists are asking lawmakers to join the bipartisan co-sponsors of the Improving Seniors' Timely Access to Care Act of 2021 (H.R. 3173; S. 3018) to modify prior authorization requirements, increase transparency and reduce delays for people covered by Medicare Advantage plans.
For more information: www.astro.org