Electronic Prior Authorization Will Help Streamline Process, but Volume of Requirements Must Decrease

March 29, 2022

On March 25, 2022, the Association for Clinical Oncology (ASCO) submitted comments to the Office of the National Coordinator for Health Information Technology (ONC) in response to the agency’s Request for Information (RFI) on electronic prior authorization (ePA).

ASCO noted the significant burdens that prior authorization places on patients and providers, which include delays in treatment and time taken away from patient care. The Association supports a more streamlined, electronic prior authorization process, but ASCO asserts that even a streamlined process is of little use without also addressing the underlying problems with prior authorization. Such problems include an overall increase in prior authorizations and a high number of “routine” prior authorizations.

ASCO’s recommendations to the agency included the following: wherever possible, necessary documentation and data should be pulled from electronic medical records without additional manual entry from the user; prior authorization request responses must be returned electronically; reasons for denials should be very specific; and status updates should include explanations for any delays and additional information that may be needed ahead of the final determination. The Association hopes that improvements earlier in the prior authorization process will lead to fewer required “peer-to-peer” communications prior to approvals.

ASCO agreed with ONC’s Electronic Prior Authorization RFI Task Force that an overall reduction in the volume of prior authorization requirements will be necessary for widespread ePA implementation. The Association also believes that a trust and verify framework for services that are routinely approved can help reduce the overall burden of prior authorization and ensure ePA uptake. Such a framework might include gold carding—where a provider can earn a reprieve from prior authorization requirements for a service after meeting a threshold of approvals for that service. ASCO has long supported policies that set thresholds for prior authorizations for items and services that are approved a vast majority of the time.

ASCO also agreed with ONC’s task force that, to ensure the widest benefits of ePA technology and to protect against the exacerbation of current health disparities, the Department of Health and Human Services should explore incentives for smaller, under-resourced providers, to support them in adopting and implementing standard ePA technology.

Read the comment letter.

Stay tuned to ASCO in Action for updates on ePA adoption as well as news, advocacy, and analysis on cancer policy.