Assessing Full Impact of Prior Authorization, Plus Electronic Prior Authorization Needed to Remove Barriers to Care

August 22, 2019

ASCO submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to a proposed rule regarding Secure Electronic Prior Authorization for Medicare Part D. Under the proposal, clinicians would be able to complete prior authorizations for Part D prescriptions online and through a more streamlined process. ASCO supports efforts to improve the prior authorization process, including electronic prior authorizations, but urges CMS to take care to avoid unintended consequences that may inadvertently delay access to care and result in harmful patient outcomes.

The proposal, if finalized, would implement new prior authorization transaction standards for the Part D e-Prescribing program as required by the SUPPORT for Patients and Communities Act. The proposed standards would begin in January 2021. The rule would also require all Medicare Part D plans to support the electronic prior authorization transaction standards developed by the National Council for Prescription Drug Plans (NCPDP). Additionally, clinicians who select the electronic option would typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy.

ASCO members have repeatedly raised concerns about prior authorization as a barrier to appropriate care, and the society’s policy statement on the impact of utilization management for cancer drug therapies outlined recommendations for appropriate implementation of prior authorization policies. While ASCO views the CMS proposal as a positive step in realizing some of the society’s recommendations, ASCO asserts that the clinical barriers posed by prior authorization will not be resolved by simply implementing an electronic submission standard.

“ASCO urges the agency to go beyond the electronic standards outlined in the rule and examine the impact of prior authorization policies on clinical outcomes,” said ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO in the comments. “This is critical for cancer patients whose clinical concerns could be exacerbated because plans rely on different clinical considerations when developing their prior authorization policies.”

ASCO supports efforts to streamline prior authorization and to improve Medicare beneficiary access to cancer drug treatments. The society applauds CMS efforts to improve patient access to prescription drugs by reducing the time it takes for a patient to receive needed medications, and ASCO appreciates the agency’s focus on alleviating administrative burden for providers.

Read the proposed rule.

For updates on this issue and breaking cancer policy news, visit ASCO in Action.