Prior authorization utilization, administrative burden, and implications for timely care.

e23035 Background: U. S. payers widely use prior authorization (PA) to manage utilization of high-cost therapies. Although intended to promote evidence-based care, PAs are associated with delays and administrative burden. Data describing variation in PA practices and comparing potential reforms remain limited. Methods: This mixed-methods MBA health policy analysis incorporated publicly available administrative data, peer-reviewed literature, federal reports, and a cross-sectional stakeholder survey. Analyses focused on PA utilization, denial rates, administrative burden, and downstream effects across Medicare Advantage, Medicaid, and commercial insurance. The focus of the analysis was on 7 potential PA reforms proposed by Congress, including electronic processes, automatic approvals, standardized appeals, expanded gold card eligibility, PA time limits, public reporting of denials and appeals, and regulation of AI use in PA processing. The survey focused on PA perceptions and selecting the most and least feasible and impactful PA reforms. Descriptive statistics summarized findings. Results: PA use was extensive across payers. Medicare Advantage plans required PA for most covered services. Denial rates varied widely, ranging from 3. 5 to 13%, with higher rates reported for specialty and time-sensitive services. Administrative costs related to PA were > 90 billion annually, the bulk borne by providers and patients rather than payers. Prior studies identified associations between PA-related restrictions and delayed initiation of cancer care, and increased downstream acute care utilization. Survey respondents (n = 40) included patients, clinicians, and insurance administration with direct PA experience. Of respondents, almost all reported negative impressions, such as frustrating” or time-consuming. Respondents identified electronic processing and automatic approvals as the most feasible and impactful strategies to improve efficiency and access. After combining the scored and survey analyses, the weighted consensus was for Congress to mandate electronic processing of PAs. Conclusions: PA remains a prominent feature of oncology care delivery and is associated with substantial administrative burden and variability across payers. This analysis highlights the importance of PA reforms to ensure timely access while ensuring evidence-based cancer care. Respondent exposure to Prior Authorization (PA). Exposure to PA Percentage Yes, as a healthcare professional 65. 0% Yes, as a patient 42. 5% Yes, as an insurance/administrative worker 12. 5% No, have not encountered PA directly 5. 0%