UnitedHealth finds promise in web-based prior authorization tool for oncologists

stethoscope and tablet

The use of a web-based tool to expedite cancer treatment approvals not only provided patients with quick access to chemotherapy drug regimens, but it also helped reduce drug costs, according to a new pilot study from UnitedHealthcare.

United conducted the pilot with its in-network oncology practices in Florida and the results were published this week in the Journal of Oncology Practice. The tool works by showing oncologists National Comprehensive Cancer Network-approved options when they make a treatment request; when they choose one of the options, they receive immediate coverage approval.

“The program puts information at oncologists’ fingertips to help them ensure that their patients will be covered for proven cancer treatments that offer the greatest promise for survival and quality of life,” Lee Newcomer, M.D., UnitedHealthcare senior vice president of oncology said in an announcement. “The objective of the pilot was to ‘get to yes’ by offering all available evidence-based treatment options at decision time.”

During the one-year pilot, 4,272 eligible cases were reviewed with only 42 treatment coverage denials, according to the study.

In comparing chemotherapy drug costs for the pilot with drug costs for the same time period in Florida a year prior, the study found costs were 9 percent lower for the pilot. Compared to United's cancer drug costs nationally, the pilot reduced cancer drug costs by 20 percent, the announcement notes.

“There is significant opportunity to reduce the costs of therapy while being compliant with nationally accepted guidelines for cancer chemotherapy,” the study concludes.

As payers increasingly look to cut down on the cost of cancer treatments, many are turning to tactics such as oncology treatment pathways and value-based payment models

Some oncologists, however, have argued that health insurers shouldn’t determine treatment pathways unilaterally.

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