"The results of a recently released survey conducted for the American Cancer Society Cancer Action Network (ACS CAN) raise serious concerns about the negative impact that utilization management practices, including prior authorization requirements, are having on patients with cancer and their physicians. The survey results reinforce ASCO’s position that payer-imposed utilization management strategies must provide people with cancer full access to the right treatment, at the right time, based on the scientific evidence on what constitutes high-quality care.
"The data in the report reflects stories we hear all too often from our patients and colleagues. For example, the ACS CAN survey shows one in three of the patients and caregivers reported delays in cancer care because their physician was waiting for their health plan to approve a prescribed treatment, test, or medicine. Such treatment delays may have deleterious consequences to a patient with cancer that is progressing. Additionally, 70 percent or more of the physicians surveyed reported that utilization management techniques are having a significant negative impact on their practice of medicine by limiting their ability to provide high-quality care and imposing significant administrative burdens that divert precious time away from direct patient care.
“ASCO’s policy statement on utilization management stresses that people with cancer should have full access to the right treatment at the right time based on their diagnosis; that utilization management policies should be evidence-based, reflecting the most current understanding of cancer treatment; and that payers should seek ways to minimize administrative burdens on both providers and patients. ASCO believes that well-designed, high-quality clinical pathways should be the first choice of payers to ensure appropriate utilization of anti-cancer drugs and the delivery of high-value care.
“ASCO commends ACS CAN for contributing this important report to the ongoing conversation about utilization management practices. The survey results provide a valuable snapshot of the current impact these policies are having on people with cancer, their loved ones, and the physicians who care for them. We will continue our work with payers on utilization management strategies that best serve patients and the cancer care community.”