Surveys Reveal Prior Authorization is a Serious Burden to Cancer Care
Updated: Sep 16, 2020
A new technology platform addresses this issue head-on by aligning oncologists, practices, labs and payers around the appropriate use of precision medicine
In a recent editorial in the Journal of Oncology Practice (Lin et al., 2018) titled Increasing Burden of Prior Authorizations in the Delivery of Oncology Care in the United States, writers Lin, Bichkoff, and Hassett zero in on the need for “new, collaborative models in which medical teams and insurers are aligned with patients to achieve timely, appropriate, and cost-effective care.” They base their opinions on recent surveys that paint a grim picture of the effectiveness of current prior-authorization processes.
According to a 2016 American Medical Association (AMA) survey of 1,000 physicians (40% primary care, 60% specialists):
More than 90% of physicians reported care delays as a result of prior authorizations (PAs)
78% reported that PAs led to treatment plan abandonment at least some of the time
61% reported PAs having a significant effect on patients
In 2017, an ASCO oncology practice census survey revealed that of 395 practices cited the most often cited payor pressures included prior authorizations (78%) and coverage denials/appeals (62%).
“To the extent that payers continue to require PAs, they should improve, simplify, and standardize the methods of requesting and granting PAs. When PAs are required, they should focus on areas where there is evidence of inappropriate overuse and reflect the best, most up-to-date evidence.” (Lin et al., 2018) This is exactly the problem Trapelo was created to address. Trapelo is the first, evidence-based technology platform used by oncologists, practices, labs, and payors that obviates the need for traditional prior-authorization and speeds access to the most appropriate treatments for cancer patients when time matters most. Trapelo does this by aligning decision-making processes with the most current published clinical evidence to ensure every patient gets the most appropriate tests from preferred labs at the right time in their treatment journey. And the platform enables real-time decision support, order entry, treatment selection, and reimbursement assurance, providing more certainty that precision medicine is being used appropriately.
“For a majority of payers, cost is the most important factor influencing biomarker coverage, followed closely by clinical validity and utility.” (The Precision Oncology Annual Trend Report, 2016) Trapelo knows what it takes to manage costs while giving every patient the best chance at beating cancer.
Some of the nation’s leading cancer centers and community oncologists along with national and regional molecular testing labs have joined Trapelo to ensure the scalable, appropriate use of precision medicine for cancer. Schedule a demo or contact us to learn more about how Trapelo helps payers align with current evidence to deliver better cancer care while managing costs.