It is a nightmare waking up every day wondering if some people halfway across the country will approve what my doctors have said is my only chance.”
That was a response of one patient in a report that found that 85% of patients with cancer faced prior authorization requirements for oncology treatments, with employer-sponsored insurance associated with the highest administrative burdens and reported negative effects. Findings from the survey, which was conducted by the patient support nonprofit CancerCare, were presented at the 2025 Community Oncology Alliance (COA) Payer Exchange Summit in Reston, Virginia.
“We have to do more to protect these folks’ access to timely care and high-quality care. And so the time for reform is now. We all can make changes and work collectively to reduce harm and support this timely access, and we all have a role to play,” said Alexandra Zaleta, PhD, associate vice president of research and insights at CancerCare.
The report included 1,201 patients with cancer who completed the survey between September and December 2024. Each of the respondents had been treated in the prior 12 months with chemotherapy, targeted therapy, immunotherapy, radiation therapy, or stem-cell transplant.
Of the patients who experienced prior authorization, 95% of the requests were ultimately approved, which Dr. Zaleta said emphasized the inefficiency of its use. In addition, 29% of the patients reported diagnosis delays, and 40% reported treatment delays. For the 485 patients who dealt directly with their most recent prior authorization, 51% lost up to a full business day and 12% spent a full business week or more managing a single incident.
Patients on employer-sponsored plans experienced the greatest burden, with 87% needing at least one prior authorization for cancer treatment compared with 72% for Medicare Advantage and 57% for traditional Medicare. In fact, 43% of respondents on employer plans had to go through prior authorization for five or more different types of cancer treatments in the past year.