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Feasibility of Multi-Institutional Data Collection for Medication Prior Authorization in Pediatric Oncology
David S Dickens1, Kathryn Juhl2, Peggy Bennett3
1Division of Pediatric Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA.
Purpose:
Medication prior authorization (mPA) occurs commonly in US cancer care. While medical oncologists report potential harm resulting from this requirement, the impact of mPA in pediatric oncology is unknown. This study's primary aim was to test the feasibility of prospectively collecting multi-institutional data on mPA in pediatric oncology, while secondarily assessing for resultant delays in care.
Methods:
Pediatric patients with cancer were enrolled between September 2021 and December 2022 at three Children's Oncology Group institutions participating in the National Cancer Institute Community Oncology Research Program. Data collected for each mPA event included the name of the medication, indication, desired initiation date, and actual date administered.
Results:
Among 68 patients enrolled at three institutions, 38 (56%) were subject to at least one mPA. A total of 69 mPAs occurred in these 38 patients, with 36 (52%) for supportive care and 33 (48%) for treatment medications. Ultimately, 61 of 69 (88%) mPAs were approved as prescribed (33 of 33 treatment mPAs) with a range of 5-240 minutes of provider/staff time required to resolve. MPAs delayed care in 15 of 69 (22%) cases with a range of 1-21 days. Most providers reported minimal or no additional burden to characterizing mPA data.
Conclusion:
Despite the complexity and variability of institutional mPA processes, it is feasible to prospectively collect multi-institutional mPA data. No cancer treatment mPA request led to alterations in prescriptions. Delays in care because of mPA affect roughly one quarter of pediatric patients with cancer, the consequences of which remain unknown.
Insights
Medication prior authorization (mPA) is feasible to study in pediatric cancer care. While most requests are approved, about a quarter of pediatric cancer patients experience care delays due to mPA.
Area of Science:
- Oncology
- Health Services Research
- Pediatric Care
Background:
- Medication prior authorization (mPA) is common in US cancer care.
- Potential harm from mPA is reported by medical oncologists.
- The impact of mPA on pediatric oncology is not well understood.
Purpose of the Study:
- To test the feasibility of prospectively collecting multi-institutional data on mPA in pediatric oncology.
- To assess delays in care resulting from mPA in pediatric cancer patients.
Main Methods:
- Prospective data collection at three Children's Oncology Group institutions.
- Enrollment of pediatric cancer patients between September 2021 and December 2022.
- Data captured included medication, indication, and initiation/administration dates for each mPA.
Main Results:
- 68 patients were enrolled; 38 (56%) experienced at least one mPA.
- 69 mPAs occurred, with 48% for treatment and 52% for supportive care medications.
- 22% of mPAs caused care delays (1-21 days); no treatment mPAs were altered.
Conclusions:
- Prospective, multi-institutional data collection on mPA in pediatric oncology is feasible.
- Medication prior authorization does not appear to alter cancer treatment prescriptions.
- Approximately one quarter of pediatric cancer patients face care delays due to mPA, with unknown consequences.
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