Patient perspectives of prior authorization: Understanding associations with care delivery and delays.

371 Background: Prior authorization (PA) is a form of insurance healthcare utilization management in which elements of care must be pre-approved to ensure financial coverage. For patients with cancer, PA can lead to delays or denials of necessary diagnostic imaging, anti-cancer therapy, and supportive care. This analysis sought to characterize patient involvement in the process, outcomes, and perception of the experience. Methods: An investigator-designed cross-sectional survey was administered through the Qualtrics Online Panel Platform to 993 U.S. adults from 12/2024–01/2025. Among participants who reported PA in the past year, logistic regression models that controlled for clinical and demographic variables examined the relationship between direct patient involvement in PA (e.g., contacting the insurance company or pharmacy, filing an appeal) and three outcomes: care approved as prescribed (yes/no), delays in receipt of care (yes/no), and patient rating of the experience (no/little problem vs. moderate/serious problem), along with the relationship between cancer diagnosis and the three outcomes. Results: PA was experienced by 286 respondents. PA was most commonly needed for medications (49%), imaging (38%), hospital stays (26%), and surgery (22%). The healthcare team handled the PA for 48% of respondents: patient involvement in the PA included contacting the healthcare team (28%), insurance company (18%), and pharmacy (16%) and filing an appeal (13%). Approval of care as prescribed was reported by 52% of respondents, while 21% noted that although their PA was ultimately approved, they received different care than originally recommended; 27% of respondents’ care was not approved. Over one-half of the sample (59%, n = 169) experienced delays in care due to PA: 28% of delays were < 1 week, 26% of delays were one week, and 46% of delays exceeded one week. Nearly one-third (31%) rated PA as a moderate/serious problem. In the sample, 23% (n = 66) reported a cancer history. In adjusted analyses, respondent involvement in PA was significantly associated with increased odds of the care not being approved and/or received (aOR = 4.58, 95% CI: 2.50-8.38), PA being a moderate/serious problem (aOR = 3.43, 95% CI: 1.80-6.52), and a delay in care (aOR = 7.88, 95% CI: 4.17-14.89). A cancer diagnosis was significantly associated with a delay in care (aOR = 2.69, 95% CI: 1.22-5.91). Conclusions: Patients who need to directly engage in PA processes are more likely to face an adverse outcome. This suggests that, in addition to policy reform to improve PA processes, healthcare teams need to continue to develop streamlined mechanisms and workflows to alleviate the burden patients face. The urgency of this need is reinforced by the higher likelihood of delay faced by patients with cancer, as they often require elements of care (e.g., pain management) for which a delay may lead to profound physical and/or psychosocial harm.