A cancer diagnosis moves fast. Tumor biology does not wait for insurance authorization, peer-to-peer reviews, or appeals processes. Yet every week, patients across the United States are told their recommended treatment requires prior authorization u2014 and the wait begins.

The Scope of the Problem

Prior authorization u2014 the requirement that an insurer approve a treatment before it can begin u2014 was designed to prevent unnecessary care. In practice, it has become one of the most significant barriers to timely cancer treatment. A 2022 American Medical Association survey found that 94% of physicians reported care delays due to prior authorization, and 33% reported it led to a serious adverse event for a patient.

For proton therapy, the prior authorization burden is especially acute. Despite growing clinical evidence supporting proton therapy for specific cancers u2014 pediatric malignancies, head and neck cancers, breast cancer requiring nodal radiation u2014 many insurers continue to apply blanket “experimental” or “investigational” classifications that have not been updated to reflect current evidence.

What Needs to Change

The solution is not to eliminate clinical oversight u2014 it is to align that oversight with the actual pace and complexity of cancer care. That means real-time peer-to-peer review by qualified oncologists, transparent criteria based on current clinical guidelines, and binding timelines that prevent delays from becoming denials by default.

Patients navigating a cancer diagnosis deserve a system that moves as fast as their disease. This is an area where policy, advocacy, and clinical community voices all have a role to play.