ASCO Perspective
“Quality cancer care means getting the right medication to the right patient at the right time. By quantifying treatment delays associated with prior authorization of oral anti-cancer drugs, this study provides necessary information to remove obstacles to patients receiving their treatment as soon as possible,” said ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO.

ALEXANDRIA, Va. – The majority (72.3%) of oral anticancer drugs received by patients required prior authorization, which was found to be associated with delayed time to drug receipt, according to a study to be presented at the 2021 ASCO Quality Care Symposium. 

Study at a Glance  

“It is clear from our work that the current process for obtaining oral oncolytics is complex and multifaceted, and that more research is needed to understand the processes in place so that we can reduce the time it takes for patients to receive prescribed oral anticancer drugs,” said lead author Morgan R.L. Lichtenstein, MD, who is a medical oncology fellow at Columbia NewYork-Presbyterian.

About the Study  
Researchers prospectively collected demographic, medical, and insurance data on all new oral anticancer drug prescriptions for adult cancer patients from January 1, 2018, to December 31, 2019. In total, 1,022 patients were prescribed 1,195 new oral anticancer drugs. Among these prescriptions, 883 patients received 1,014 oral anticancer drugs. First the researchers looked at time to receipt of prescriptions and factors associated with prior authorization among patients who received their medications (n = 833). They next looked at all new prescriptions for oral anti-cancer drugs (n = 1,195), regardless of prescription receipt or failure, with failure defined as a prescription that never reached the patient. Both model-based analyses included prior authorization, drug type (targeted treatment, hormone treatment, chemotherapy), and insurance type (Medicare, Medicaid only, commercial only) as potential factors associated with time to receipt.  

Key Findings 
The researchers found that among the 883 patients who received their prescriptions, close to three-quarters (72.3%) of oral anticancer drug prescriptions required a prior authorization. The median time to receipt of drugs was 7 days (range 0 – 142 days) with a quarter of patients (25%) waiting more than 14 days for their medication, and 5% waiting more than 30 days. Prior authorization was associated with delayed time to receipt.

The researchers also found that patients prescribed targeted oral anticancer drugs were three times more likely to have a prior authorization than those prescribed oral chemotherapy. Prescriptions for oral hormone therapy were more than four times more likely to have a prior authorization.

 The researchers also looked at prior authorization and time to receipt of drug for patients with different types of insurance (Medicare, Medicaid only, and commercial only). Those with Medicaid were nearly two times more likely to have a prior authorization compared to patients with Medicare. Medicaid was also associated with a shorter time to receipt compared to other insurance types. 

The second analysis included all prescriptions, regardless of whether the prescription was ultimately received by the patient. The researchers looked at time to receipt or failure and potentially associated factors, including prior authorization, insurance type, age, and diagnosis. Of all 1,195 prescriptions, 87% were received and 71% had a prior authorization issued. The researchers also found that targeted oral anticancer drugs (including hormone agents) have a significantly longer time to receipt than oral chemotherapy. 

Among prescriptions for targeted therapies, prior authorization and solid tumor diagnosis were each associated with a higher likelihood of patients receiving the drug. Older age was associated with a shorter time to receipt or failure to receive oral anticancer drugs. Prior authorization was associated with a longer time to oral anticancer drug receipt or failure. Notably, additional analysis revealed that among Medicaid patients specifically, prior authorization was associated with a shorter time to oral anticancer drug oral anticancer drug receipt or failure to receive. 

Next steps  
The researchers plan to expand this study across multiple centers and specialty pharmacies and will collect more details about the prior authorization process in order to capture additional factors that may contribute to failed or delayed receipt of oral anticancer drugs. Ultimately, they aim to use this data to improve the time it takes for patients to receive their oral therapy.  

Funding  
This study received funding from the United States National Institutes of Health.    

View the full abstract 

For your readers:  

• Health Insurance  
• Making Decisions About Cancer Treatment  
• Drug Information Resources  

 View the disclosures for the 2021 ASCO Quality Care Symposium News Planning Team: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2021-qcs-npt-disclosures.pdf

View the disclosures for Dr. Gralow: https://coi.asco.org/share/CKD-HYVM/Julie%20Gralow

ATTRIBUTION TO THE 2021 ASCO QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.

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