INSURASALES

ASTRO Supports Prior Authorization Reform in Medicare Advantage to Improve Cancer Care

The American Society for Radiation Oncology (ASTRO) has endorsed bipartisan federal legislation aimed at reforming prior authorization processes within Medicare Advantage. The Improving Seniors’ Timely Access to Care Act of 2025 seeks to mitigate administrative barriers that delay timely access to cancer treatments, particularly radiation therapy. These delays have been linked to adverse patient outcomes and increased emergency interventions.

The bill, supported by a coalition of senators and representatives, proposes increased transparency and oversight in Medicare Advantage prior authorization policies. ASTRO highlights that prior authorization requirements currently lead to significant treatment delays, with nearly 70% of patients experiencing waits of a week or longer, complicating the delivery of timely oncologic care.

Radiation oncologists report facing higher prior authorization obstacles than other specialists, jeopardizing patient outcomes as delays in radiation initiation correlate with increased mortality risk. Despite these challenges, Medicare Advantage prior authorization has not been shown to reduce healthcare spending effectively and may lead to higher overall costs compared to traditional Medicare.

ASTRO advocates for a shift away from fee-for-service payment models, which incentivize granular insurer control via prior authorization. Instead, the organization recommends bundled payment methodologies, such as the Radiation Oncology Case Rate (ROCR), to provide clinicians with more autonomy and reduce administrative burdens. This approach aims to enhance clinical flexibility and reduce delays caused by insurer micromanagement.

The reform effort represents a targeted response to systemic inefficiencies impacting Medicare Advantage beneficiaries requiring cancer care. ASTRO urges prompt legislative action to improve care delivery efficiency and patient outcomes in radiation oncology within the Medicare Advantage framework.