Study: Automated prior authorization may lower costs, improve care for cancer patients

A new study from researchers at CVS Health finds that an automated prior authorization process may drive lower cost, more efficient cancer care.

The research, released for the American Society of Clinical Oncology conference, found that from April to December 2020, 279 prior authorization requests were submitted by a large health system through the Novologix platform, a clinical decision support tool for prior auth.

Of those submissions, 83% were automatically approved in real time, according to the study. None of the submissions were ultimately denied, according to the researchers, and those not approved automatically were reviewed via a partnership with the National Comprehensive Cancer Network.

CVS developed Novologix to provide a more streamlined care management option for oncology treatment, based in the NCCN guidelines, and is available to all of its health plan clients, Roger Brito, divisional head of enterprise oncology at CVS Health, told Fierce Healthcare.

"Because the platform enables prior authorization of treatment at a regimen level rather than requiring prescribers to submit each drug individually, it delivers a better member and prescriber experience and helps ensure that patients can get started on the most clinically appropriate treatment for their specific diagnosis in a timely manner," Brito said.

RELATED: House bill mandates Medicare Advantage plans adopt electronic prior authorization

Medicare Advantage patients with non-small cell lung cancer whose care regimens were aligned with the NCCN guidelines saw significant cost savings, the study found.

The researchers found the average cost of care for patients who met these guidelines was $19,321 compared to $26,405 for those who were not.

The researchers said that the findings suggest that payers and providers collaborating on automating processes to drive toward the latest clinical guidance can lead to higher quality care at a lower cost. 

However, they said further study is necessary to delve into the impacts on other care models and in other types of cancer.

Other recent studies have delved into this issue, as prior authorization is a commonly-cited pain point for physicians. America's Health Insurance Plans, for example, found that more electronic and automated prior authorization can speed up patients' access to therapies and reduce the need for administrative busywork, such as sending faxes.

"Where treatment decisions align to established clinical guidelines it is in everyone’s best interest to simplify and automate the prescribing and prior authorization process through a technology platform like Nolovogix," Brito said.