Half get directly involved in prior authorizations, which often pose substantial time burden
By Lori Solomon HealthDay Reporter
FRIDAY, Oct. 17, 2025 (HealthDay News) — Many people with cancer get directly involved in prior authorization (PA), often facing substantial time burdens, according to a study presented at the 2025 American Society of Clinical Oncology Quality Care Symposium, held from Oct. 10 to 11 in Chicago.
Alexandra Zaleta, Ph.D., from CancerCare, and colleagues examined the frequency of patient involvement in PA, the time burden incurred, and factors associated with involvement. The analysis included 1,201 adults (aged 26 years and older) with cancer who completed a survey (32 percent with breast cancer, 12 percent with prostate cancer, and 11 percent with hematologic cancer).
The researchers found that 74 percent of respondents experienced PA between 2022 and 2024 and were covered by employer insurance (55 percent), Medicare Advantage (31 percent), and traditional Medicare (14 percent). Half of respondents reported direct involvement by self/family in their most recent PA, while the others said the health care teams fully handled PA. Among respondents involved, 50 percent spent up to one business day (one to eight hours), 29 percent spent two to three days (nine to 24 hours), and 12 percent spent a full business week or more (>41 hours) on PA. There were significant differences in involvement (Ps < 0.05) for targeted therapy (73 percent involved versus 27 percent health care team alone), supportive medications (64 percent versus 36 percent), radiation (40 percent versus 60 percent), and imaging (40 percent versus 60 percent). There were significantly greater odds of involvement for those younger than 65 years with employer plans (odds ratio [OR], 3.70) and those younger than 65 years on Medicare (OR, 2.06) versus those 65 years and older on Medicare. Significantly greater odds of involvement were also seen for men (OR, 2.12); those with advanced disease (OR, 2.06); those with delays in diagnosis (OR, 1.66) or treatment (OR, 1.54) due to PA; those with greater negative insurance-related impacts (physical, emotional, and financial well-being; OR, 1.23); and those with greater cost-related medication scrimping (OR, 1.21).
“By documenting the scale of this hidden burden, our research shows that prior authorization is not just an administrative step — it’s a serious barrier to quality care,” Zaleta said in a statement.
Several authors disclosed financial ties to the pharmaceutical industry, including one to AstraZeneca, which funded the study.
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