New study finds no racial or ethnic disparities in insurers’ prior authorization for cancer treatments

Prior authorization is a tool insurers use to make sure individuals receive appropriate treatments that are based on evidence and avoid care that may be harmful. Clinicians request prior authorization from insurers on behalf of their patients, often providing clinical documentation to support the submission.

To learn more about this issue, Texas A&M University School of Public Health researcher Benjamin Ukert, PhD, and colleagues analyzed health insurance data to explore possible racial and ethnic disparities in prior authorization outcomes among cancer patients.

For their study, published in The American Journal of Managed Care, the researchers used claims and prior authorization data from Elevance Health, a large commercial health insurer, from January 2017 to April 2020, along with data on race or ethnicity and other clinical and demographic factors in their analysis.

The analysis looked at three outcomes: the number of days that passed between a cancer diagnosis and submission of prior authorization request by the clinician, the proportion of prior authorizations denied within six months after diagnosis and the rate of prior authorization denial due to the proposed treatment being considered not medically necessary. Ukert and colleagues used self-reported race or ethnicity along with age, sex, type of cancer, residence location and other variables in their analysis.

“We found that it took an average of 45 days between diagnosis and prior authorization submission for all patients,” Ukert said. “White patients waited an average of 46 days for submission while non-white patients waited 43 days on average.”

The researchers also found an overall denial rate of 10 percent, with 5 percent of denials being due to lack of medical necessity. Denial rates for different racial and ethnic groups were largely similar, apart from a lower denial rate for Asian patients compared to white patients.

“Our analysis did not identify differences in the number of days between diagnosis and prior authorization request between racial and ethnic groups,” Ukert said. “It did, however, find somewhat lower denial rates among Asian patients compared with white patients, though the mechanisms are unclear.”

Ukert and colleagues note that more research is needed to more fully understand possible disparities in prior authorization among different patient populations. They also noted a few limitations to their study, such as the time period studied, the self-reported nature of the race and ethnicity data, and the fact that the analysis focused on a single health insurer.

Despite these limitations, this study’s findings indicate that racial and ethnic disparities are not likely to be driven by the prior authorization process. Future research focusing on larger populations covered by different insurers could clarify things further.

“Research that investigates factors like the number of cancer specialists in a given area could shed more light on factors influencing the time between diagnosis and submission of prior authorization request,” Ukert said. “Having a better understanding of factors affecting prior authorization among cancer patients will be vital for efforts to improve care and health outcomes.”