Disparities in prior authorization for gynecologic cancer care (137)

Objectives: Significant insurance, age, and race disparities exist in gynecologic cancer care. It remains unknown whether insurer-based prior authorization requirements may exacerbate disparities. Our objective was to examine whether the frequency of prior authorization differed by insurance type or race in gynecologic cancer care. Methods: We performed a retrospective review of electronic medical records of patients seen in the University of Pennsylvania gynecologic oncology practice from January 1 to March 31, 2021. Our academic practice consists of eight gynecologic oncology attendings and three nurse practitioners across four clinical sites associated with two hospitals. Race was self-reported, and insurance type was assessed from patients’ scanned insurance cards. We used univariate and multivariate log-binomial models to estimate the association of insurance type and race with the likelihood of prior authorization during cancer care. Results: There were 2,112 clinic visits of 1,403 unique patients from January to March 2021. Eighteen percent of visits occurred via telemedicine; 23% (95% CI: 20.7-25.1) of patients had experienced a prior authorization during their gynecologic oncology care, and 4.4% (95% CI: 3.3-5.5) experienced 2+ prior authorizations. Of the prior authorizations, the majority were requested by private payers (56.2%, 95% CI: 53.5-58.8), followed by 20.9% (95% CI: 18.8-23.0) for Medicare fee-for-service, and 11.5% (95% CI: 9.8-13.1) for Medicare Advantage. In univariate analysis, having Medicare Advantage and being of Asian descent was associated with an increased risk of prior authorization, and having traditional Medicare was associated with a decreased risk. In multivariate analyses, having Medicare Advantage had an association with a 76% increased risk of experiencing prior authorization (95% CI: 1.27-2.44). Being of Asian descent was associated with a 60% increased risk of experiencing prior authorization (95% CI: 1.16-2.21). Conclusions: Prior authorization disproportionately impacted patients with Medicare Advantage and women of Asian descent in our study of gynecologic oncology patients. Addressing insurance barriers to care may help reduce disparities in gynecologic cancer care, especially for elderly patients. Objectives: Significant insurance, age, and race disparities exist in gynecologic cancer care. It remains unknown whether insurer-based prior authorization requirements may exacerbate disparities. Our objective was to examine whether the frequency of prior authorization differed by insurance type or race in gynecologic cancer care. Methods: We performed a retrospective review of electronic medical records of patients seen in the University of Pennsylvania gynecologic oncology practice from January 1 to March 31, 2021. Our academic practice consists of eight gynecologic oncology attendings and three nurse practitioners across four clinical sites associated with two hospitals. Race was self-reported, and insurance type was assessed from patients’ scanned insurance cards. We used univariate and multivariate log-binomial models to estimate the association of insurance type and race with the likelihood of prior authorization during cancer care. Results: There were 2,112 clinic visits of 1,403 unique patients from January to March 2021. Eighteen percent of visits occurred via telemedicine; 23% (95% CI: 20.7-25.1) of patients had experienced a prior authorization during their gynecologic oncology care, and 4.4% (95% CI: 3.3-5.5) experienced 2+ prior authorizations. Of the prior authorizations, the majority were requested by private payers (56.2%, 95% CI: 53.5-58.8), followed by 20.9% (95% CI: 18.8-23.0) for Medicare fee-for-service, and 11.5% (95% CI: 9.8-13.1) for Medicare Advantage. In univariate analysis, having Medicare Advantage and being of Asian descent was associated with an increased risk of prior authorization, and having traditional Medicare was associated with a decreased risk. In multivariate analyses, having Medicare Advantage had an association with a 76% increased risk of experiencing prior authorization (95% CI: 1.27-2.44). Being of Asian descent was associated with a 60% increased risk of experiencing prior authorization (95% CI: 1.16-2.21). Conclusions: Prior authorization disproportionately impacted patients with Medicare Advantage and women of Asian descent in our study of gynecologic oncology patients. Addressing insurance barriers to care may help reduce disparities in gynecologic cancer care, especially for elderly patients.