Intervention Insights CEO Clynt Taylor told Becker's ASC Review how physician-owned practices are increasingly burdened by prior authorization processes.
Note: Responses were lightly edited for style.
Question: What are the main issues with traditional prior authorization processes?
1. It is inefficient and unscalable. The use of molecular testing is growing at an average of over 24 percent annually, and 73 percent of new drugs in the pipeline are targeted therapies, each requiring appropriate molecular testing. With the availability of new liquid biopsies that may be appropriate even more frequently, the 'mother-may-I?' approach creates an unscalable bottleneck.
2. It requires additional expensive expertise by payers. Requiring prior authorization first for the testing, and then for the drugs selected actually doubles the level of expertise and associated costs for payers. Payers need scientists who can help determine which tests to perform, to stay in-step with MDs and pharmacists who are skilled in the use of cancer drugs.
3. It only solves for half the problem. Traditional PA manages over-testing, not under-testing. Sure, there are doctors that order molecular tests too often and in larger panels than may be appropriate to get to an actionable result, but there are also doctors who don't order tests for patients who should be tested. The latter can lead to missed opportunities to get patients on the most effective treatment, causing harm to patients and unnecessary overspending on less effective or noneffective treatments.
4. It adds to confusion without proof of lowering testing costs. Health plan policies that may work for drug utilization don't always translate as effectively in managing the use of molecular testing. Precision medicine is constantly changing, faster than policies in molecular testing can be updated. That means they don't always perfectly align with published clinical evidence. This can cause confusion when the policies fall out of step with most current evidence. Confusion causes variability in care, missed opportunities to get the treatment right and unnecessary delays. And there is little or no evidence that a traditional prior authorization process for molecular testing actually saves money.