Objective: Prior authorization is used to ensure providers treat patients with medically accepted treatments. Our objective was to evaluate prior authorization decisions in cancer care by race/ethnicity for commercially insured patients.
Study design: Retrospective study of 18,041 patients diagnosed with cancer between January 1, 2017, and April 1, 2020.
Methods: Using commercial longitudinal data from a large national insurer, we described the racial and ethnic composition in terms of prior authorization process outcomes for individuals diagnosed with cancer. We then used linear regression models to evaluate whether disparities by race or ethnicity emerged in prior authorization process outcomes.
Results: The self-identified composition of the sample was 85% White, 3% Asian, 10% Black, and 1% Hispanic; 64% were female, and the mean age was 53 years. The average prior authorization denial rate was 10%, and the denial rate specifically due to no medical necessity was 5%. Hispanic patients had the highest prior authorization denial rate (12%), and Black patients had the lowest prior authorization denial rate (8%). Regressions results did not identify racial or ethnic disparities in prior authorization outcomes for Black and Hispanic patients compared with White patients. We observed that Asian patients had lower rates of prior authorization denials compared with White patients.
Conclusions: We observed no differences in the prior authorization process for Black and Hispanic patients with cancer and higher rates of prior authorization approvals for Asian patients compared with White patients.