Patient Perspectives on Prior Authorization for Cancer Care

Health insurance companies may require prior authorization at any stage in the cancer care continuum, leading to the potential for denials and/or delays of diagnosis, treatment, or survivorship care. Patient experiences with prior authorization are largely unexplored, with most surveys focused on clinicians.

To characterize prior authorization for cancer care from the perspective of patients with cancer, using their own words.

This qualitative study provided a secondary thematic analysis of an online survey created in collaboration with patient advocates. Data were collected from July to October 2022. The survey was offered through a secure online platform. Participants included a convenience sample of patients with cancer, who self-reported being older than 18 years and having previous experience with prior authorization, recruited from social media, email lists, and word of mouth. Data were coded in May 2023, with initial themes constructed in September 2023.

Responses to the open-ended prompt were coded inductively by trained members of the research team, and themes were developed by the study team through discussion.

Of 178 respondents in the parent quantitative survey, 89 (50%) provided free-text responses. Most respondents to the open-ended question were women (79 [89%]) and aged 18 to 39 (35 [39%]) or 40 to 54 (31 [35%]). Codes from responses related to patient experiences, views of the process, and perception of the role of the health care team. Four interconnected themes were created from the codes: blinded navigation, intersecting burdens, interference with care, and a broken system.

In this qualitative secondary analysis of patient experiences with prior authorization, themes centered on how, from the patient perspective, prior authorization was a confusing process that added to the administrative, psychosocial, and financial burdens of cancer care. Intersecting burdens amplified the negative impact of prior authorization on patients. Patients voiced concerns that highlighted the broken, profit-driven nature of the United States health care system. Advocacy efforts are needed to promote reform to ensure patients receive timely access to recommended care, and policy considerations toward this reform must center the patient experience.