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Myndshft Blog

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April 25, 2023

Navigating Biomarker Obstacles: The Role of Prior Authorization Software in Personalized Cancer Therapy

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Between 2000 and 2018, the use of biomarkers in oncology clinical trials grew from 15% to 55%, for good reason. The use of biomarkers in cancer care enables personalized treatment options, revolutionizing the way oncologists diagnose and treat cancer patients. Biomarkers can help identify the most effective therapies for individual patients. Despite the proven benefits of biomarker testing, however, many cancer patients still face barriers to accessing this essential tool due to prior authorization. By automating the prior authorization process, oncologists can expedite personalized cancer care, increasing the chances of successful outcomes and reducing unnecessary treatments. 

Prior authorization creates roadblocks to timely treatment

Prior authorization, a process that requires healthcare providers to obtain approval from payers before performing specific tests or treatments, often slows treatment for cancer patients. A time-consuming, cumbersome process when done manually, prior authorization often leads to care delays. This is especially concerning with biomarker testing, which can serve as a guide when determining the most appropriate treatment path for individual patients. 

Moreover, burdensome prior authorization protocols, such as requiring extensive documentation, limiting the number of tests covered, or setting high cost-sharing rates can discourage biomarker testing. In turn, this restricts patients’ access to potentially life-saving therapies. As a result, cancer patients may be forced to either forgo biomarker testing or bear the financial burden themselves, which contributes to disparities in access to the most effective treatments.

Barrier also contributes to health inequities in cancer care 

Research shows significant gaps in the rate of biomarker testing between different racial, ethnic, and socio-economic groups. These disparities can hinder access to the most effective treatments and contribute to inequalities in clinical trial participation, further widening the gap in cancer outcomes between different populations. And inequities aren’t limited to clinical trials. 

For example, a study published by the Journal of the National Comprehensive Cancer Network found that Medicaid beneficiaries with small cell lung cancer were 19% less likely to receive biomarker testing and 30% less likely to receive biomarker-driven therapy than commercially-insured patients. 

To overcome these barriers, it is vital to streamline and simplify the prior authorization process for biomarker testing in cancer care. Implementing prior authorization software can help healthcare providers efficiently manage and track authorization requests, reducing the time and resources spent on administrative tasks. Additionally, automated prior authorization helps providers navigate complex insurance requirements, improving the chances of obtaining coverage for critical biomarker tests.

The tide is shifting in favor of biomarker testing

While the most important impact of biomarker testing is the personalized care patients experience, that isn’t the only benefit. According to a new survey released by CancerCare, 20% of cancer patients avoided unnecessary chemotherapy or radiation as a result of biomarker therapy and 10% became eligible for a clinical trial. Avoiding such treatments benefits both patients and payers. 

The positive results driven by biomarker therapies have led 11 states— including Arizona, California and Illinois—to enact mandates that health plans cover biomarker testing for cancer patients. In addition, 18 more states are considering legislation aimed at providing consistent coverage for biomarker testing and therapies. 

Automated prior authorization knocks down barriers

Accelerating prior authorizations for biomarker testing in cancer care helps ensure that patients have access to the most effective, personalized treatments. A report on the evolution of biomarker use in clinical trials notes, “Ultimately, biomarker-driven personalized medicine approaches will lead to better patient outcomes by enabling early detection; identifying treatment responders; and monitoring treatment, response, and targeted therapeutic effect.” 

By integrating prior authorization software within your EHR, you empower your staff and clinicians, paving the way for more equitable, efficient, and patient-centered cancer care.

Ready to see automated prior authorization in action? Connect with us to arrange a demo.