Impact of prior authorization for oncology medications on practices with majority rural patient populations.

55 Background: Prior authorization (PA) processes are known to create administrative burdens and delays in care, but little is known about how these challenges impact rural oncology patients and practice settings. Methods: To understand the broad impact of prior authorization on rural oncology patients and practices, we conducted this study across three community oncology practices serving majority rural patient populations with distinct geography, healthcare infrastructure, and models of care. Sites included one critical access hospital system located in a highly-rural community (Lakewood Health System; Staples, Minnesota), a community-based hub-and-spoke hospital system-based practice located in a mid-sized community (Mayo Clinic Health System – Northfield; Northfield, Minnesota), and a standalone referral level III trauma center serving a highly rural patient base (Self Regional Healthcare; Greenwood, South Carolina). This retrospective cohort study examined all intravenous and subcutaneous cancer-directed therapy plans (no oral therapy) that required PA submission at these locations over a three-month period from October 1, 2024 to December 31, 2024. Results: 129 PA submissions were required during the study period. 82 were due to cancer-directed therapy agents (of which 14 were immunotherapy agents), and 47 were due to adjunctive therapies (of which 22, 16, and 9 were due to granulocyte stimulation, bone preservation, and anti-emesis agents, respectively). All 129 PA submissions ultimately resulted in approval of the desired medication or formulary-approved biosimilar. Delays from PA submission to approval ranged from 0 to 18 days. A total of 209 patient-days were delayed due to PA during the study period, which did not ultimately result in change of care or denial of care in any instance. Conclusions: At all sites included in this study, all PA submissions were eventually authorized. The PA process was found to introduce inconsistent and potentially avoidable delays for hundreds of patients and their care teams. These findings highlight the inefficiency of current PA processes among rural cancer populations and the practices that care for them, underscoring the need for ongoing efforts directed at state and federal PA reform.