National Association For Proton Therapy (NAPT) Welcomes CMS Rule To Improve Prior Authorization, Remains Committed To Further Improving Patient Access To Proton Therapy

Nationwide Affiliation for Proton Remedy (NAPT)

The National Association for Proton Therapy (NAPT), the nation’s main group devoted to rising affected person entry to probably the most superior most cancers therapies, commends CMS for guaranteeing seniors have well timed entry to medical care, particularly superior most cancers therapies, by way of the Advancing Interoperability and Enhancing Prior Authorization Processes (e-PA) Rule.

Ultimate Rule

The ultimate rule requires that starting in 2026, Medicare Benefit (MA) plans should convey PA determinations inside 72 hours for expedited requests and 7 days for normal requests. MA plans should additionally element a selected motive for denying a PA attraction and report PA metrics as a part of new transparency and reporting necessities.

“For Medicare beneficiaries who want proton remedy and different superior most cancers therapies, prior authorizations create a burdensome course of that usually delays life-saving therapy. This new rule places payors on discover that CMS is critical about eradicating obstacles to care and sparing sufferers the irritating and probably dangerous expertise of ready days or perhaps weeks for a protection choice.”

In line with information launched by NAPT, the burden of prior authorizations is steadily rising amongst proton remedy facilities. In a 2022 survey, it was revealed that 64 % of sufferers referred for proton remedy skilled a mean wait time of greater than 5 days for prior authorization requests, a notable rise from 48.1 % in 2021. As well as, 22 % of those sufferers confronted a mean wait time of over 11 days, up from 14.7 % within the earlier 12 months. These delays is usually a matter of life and dying, as evidenced by a 2019 Cleveland Clinic research that linked every week of therapy delay to a 1.2-3.2 % elevated danger of dying amongst most cancers sufferers.

In a current survey carried out by the American Society of Medical Oncology (ASCO), their members reported {that a} majority of their sufferers have skilled hurt resulting from prior authorization processes with 96% reporting delays in therapy and 94% of sufferers compelled to obtain second-choice remedy. One other survey, in 2018 by the American Society for Radiation Oncology (ASTRO), discovered that 93 % of radiation oncologists had encountered affected person therapy delays resulting from prior authorizations, with 31 % reporting delays lasting greater than 5 days – equal to a full week of ordinary radiation therapy.

Conclusion

“The announcement by CMS represents a constructive step within the route of streamlining the prior authorization course of,” mentioned Dr. Charles Simone, Chief Medical Officer of the New York Proton Middle. “Whereas I significantly commend this development, you will need to acknowledge the prevailing gaps that necessitate additional consideration. It’s essential to emphasise the importance of guaranteeing all sufferers have entry to well timed prior authorization processes. The final word goal stays a streamlined course of that unequivocally prioritizes entry to most cancers care with out undue delays.”

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