ASTRO Supports CMS Revision for Medicare Advantage Prior Authorization

The American Society for Radiation Oncology (ASTRO) issued the following statement from Geraldine M. Jacobson, MD, MBA, MPH, FASTRO, Board of Directors Chair, in response to the Centers for Medicare and Medicaid Services (CMS) final rule that revises the Medicare Advantage prior authorization process.

"ASTRO applauds this final rule from CMS, which is a major step in reforming the broken, burdensome prior authorization system. Changes that increase transparency, reduce care disruptions and improve coverage criteria guidelines used by Medicare Advantage plans will bring much-needed relief to physicians and our patients with cancer. We appreciate that CMS addressed an array of concerns raised by ASTRO, the radiation oncology community and physicians nationwide.

The delays and interference associated with prior authorization are unnecessarily burdensome for radiation oncologists, who face the most significant prior authorization hurdles of any medical specialty. Based on ASTRO research, 90% of radiation oncology practices report that prior authorization delayed their patients’ access to life-saving cancer treatments, and a majority say the average delay lasts a week or longer.

While we are optimistic about these reforms, we also urge CMS to hold insurance companies accountable for following the new requirements. We also eagerly await additional rulemaking to address the substantial administrative burden created by prior authorization. Further changes such as streamlining the approval process and establishing determination timelines will be necessary to truly repair this broken system.”