Cutting Delays in Cancer Care With Centralized Prior Authorizations

Andrea Ledford, PharmD, MBA, BCOP, BCSCP, FASHP, FHOPA

Prior authorizations have become a significant barrier to timely cancer care, with even low-cost medications like anti-nausea drugs and antibiotics now requiring approval. At Orlando Health Cancer Institute, a centralized prior authorization model is addressing this growing challenge head-on.

According to Andrea Ledford, PharmD, MBA, BCOP, BCSCP, FASHP, FHOPA, and a presentation at the 2025 Association of Cancer Care Centers (ACCC) Annual Meeting & Cancer Center Business Summit, by shifting the administrative burden from oncologists and clinical staff to a dedicated team of pharmacy technicians, the institute has streamlined the approval process, significantly reducing turnaround times. This innovative approach allows physicians to focus on patient care while ensuring faster access to critical medications.

“What we have been able to see is a reduction in the wait for prior authorizations at the same time that the number of prior authorizations in the state of Florida has accelerated. We see it as a win for our patients, [and] our physicians are happy with the process that we have,” explained Ledford, senior pharmacy director, oncology services, Orlando Health Cancer Institute, in an interview with Targeted Oncology^TM.

The success of this model highlights a practical solution to a widespread problem in oncology, and may offer other cancer centers faced with the increasing demands of prior authorizations a blueprint for their own institutions.

In the interview, Ledford discussed this centralized model, how it is being used at her institution, and its potential to improve patient outcomes.

Targeted Oncology: Can you provide some background on this abstract being presented at the ACCC meeting?

Ledford: I am the Pharmacy Senior Director, so I am in charge of all of our chemotherapy that we make here for infusion and injections. I have a clinical pharmacy team that works in the clinic—clinical pharmacists alongside the medical oncologists—and they focus on oral chemotherapy monitoring. That is really a great program. The physicians love it, the patients love it, and it really is quite beneficial.

Then, I also have a team that works with drug manufacturers' advocacy programs that they offer to help patients get access to expensive medications. These are patients who are either underinsured, maybe they have no insurance at all, or they are going through a rough financial time at the same time that they are dealing with a troubling health condition such as cancer. It could be that they have extraordinarily high copays that affect their operational functioning budget at home. Many of these patients, when they are on active treatment, are not able to work 40 hours a week, or they are on disability, and they are having a reduced income for that period of time. So, it can make it really challenging. And many folks have more than one family member in the household, including small kids. I just think that, in general, things are a lot more expensive than they used to be a couple of years ago.

But with all of that being set aside, we try our best to take care of all of our patients, to make sure that they can, as they're diagnosed, start their chemotherapy treatments right away. We want them to feel like they have started their journey to recovery as fast as possible. But at Orlando Health Cancer Institute, we are seeing the same problems that all the other oncology providers are seeing across the country. ASCO and ACCC have reported that providers across the industry are seeing a lot of treatment delays and patient harm in oncology patients because of prior authorizations.

What we have seen in the state of Florida is that even inexpensive medications that patients are prescribed to help them get through their cancer treatments or improve their quality of life—such as anti-nausea medications, pain medications, antibiotics if people are sick—even medications that cost less than $30 a month now all require prior authorization if you are a managed care patient, which is more often the case. And then we are also seeing a trend that Medicare patients are choosing advantage plans that have a managed care component to those as well. From the managed care perspective, they are trying to make sure that patients are being treated according to guidelines and that you're following the data and the literature. But what it is causing is just a tremendous amount of patient delays.

If we have a patient who is experiencing nausea and vomiting, we do not want the patient to have to wait 3 days to be able to pick up their prescription at the pharmacy department or have to wait 2 or 3 days for an oral antibiotic that is even a generic formulation. This is not the most expensive antibiotic that you could find, but many of them are requiring prior authorization. So, what we have decided to do here is to create a centralized prior authorization model and remove some of the administrative burden from our oncology clinics. This allows our medical oncologists, the nurses, the MAs in the clinic, to concentrate on seeing the patients that are there.

Then, I have a team of pharmacy technicians, many of whom actually work remotely most days now. They have access to the electronic medical record, and they are able to go into the patient's chart, pull the ICD-10 codes, and they can submit all of that through the managed care portal or through a CoverMyMeds process. This greatly reduces the turnaround time and the internal processing time for the prior authorization.

DNA helix enlarged model in bright colors and spots: © Radomir Jovanovic - stock.adobe.com

What we have been able to see is a reduction in the wait for prior authorizations at the same time that the number of prior authorizations in the state of Florida has accelerated. So, we see it as a win for our patients. Our physicians are happy with the process that we have. Our ancillary staff, our nurses, our advanced care providers are also seeing benefits because it is allowing them to see other patients and to move that administrative burden to another discipline where those team members can also work at the top of their license.

We are using a lot of secure health messaging between the groups because it just makes it faster than phone calls, and we are seeing some positive returns on the investment dollars of the program. The nurses are very relieved—that would be the word that I would use. In any of the situations that occur where the pharmacy team needs to reach out to the managed care providers to get the prior authorization, sometimes things just get stuck in the system for whatever reason. The pharmacy team will be the ones to take over the ownership of those calls as well.

Also, what we are starting to do—our next steps—is having our clinical pharmacists actually do the peer-to-peer and the appeal process and pull that off of the medical oncologists and the advanced practice providers as well. That is for the prescribing of our intravenous chemotherapy and injections. We have piloted that in a different area that is not going to be featured in this particular publication, but it is our next step, and we are getting ready to expand that as well.

What would you say is the biggest challenge in implementing this prior authorization team at the center?

So, one of the biggest challenges is that the managed care companies themselves seem to be having a trend—and I don't know how you can find this information out to validate it—but instead of using a common portal that many healthcare entities use, like the CoverMyMeds platform, they are coming up with their own company platform. So, that means that these team members then have to have multiple logins and now have to know other portals besides the ones that we work with in our EHR.

So, they will just pivot—and you do not have to put this quote in here—but the managed care companies will just pivot, and they'll decide they're going to do it a different way and not tell anybody. That creates a lot of delays, or who they tell it doesn't get trickled down to the end users. Then, we end up having to call to find out why the prior auth didn't go through, and we're told, "Oh, we have to use our portal now." So, then you have to get them set up as users, and more passwords—you know, the number of passwords that we have to keep up with these days is quite a lot.

We are just trying to get—and some of these are meds that our patients are chronically on, and they were approved. But now, because of the new year, their insurance company made a change, and now it no longer processes the same way. So, that has been a change in the industry—just how the approval systems work, because they can vary from insurance company to insurance company or from state to state. So, you can have, like, Blue Cross in Virginia might not work the same way as Blue Cross in Florida.

What are some key lessons learned from implementing this program that you believe other institutions could apply in the future?

To have clear communication and have the team members know each other and develop the relationship with one another. Because that way, a nurse will feel less apprehensive to hand off that patient to somebody else if they know they are going to follow up with them, and they just know that they are there. That is what I've noticed. So, if you're a new team member coming in, you need to be oriented to the process and meet the individual that is going to be doing the prior authorization work for their patients. Because the clinic side has that relationship with the patient, and they want to just make sure their patient's getting taken care of.

How do you see this model evolving as prior authorization requirements continue to change?

I think everybody in the community would like to see less prior authorizations and a more streamlined or bundled approach. So, if you have an authorization on file for IV chemotherapy, it would be nice that we did not need to get prior authorization for anti-nausea medications or support meds that go with the treatment of those patients. If the cost of the drug is below a certain price point, then prior authorization shouldn't be required if the drug costs the insurance company less than $30 a month. Because it is just creating a huge amount of administrative burden and, quite frankly, the detriment is to the patient, because it delays them getting started on medications that can improve their quality of life and prevent patient harm.

If you cannot get an anti-nausea medication to a patient, they may have to go to the emergency room when, if they could have had that a few hours earlier, they didn't get dehydrated. But if you have a prior authorization in the middle of all of that, a prior authorization process can take up to three or four days. Now, with our integrated process, we are less than 48 hours for most of our internal prior authorizations. But if you're waiting for an anti-nausea medication or an antibiotic, I would argue that that's too long.

What advice would you give to other oncology centers looking to streamline their medication prior authorization processes?

The centralized approach has given us a lot of advantages because it allows the clinics to focus on patients that have acute needs there. And then, that communication back and forth between the prior authorization team and the clinics and the patient to let them know that the medication is approved is ideal. So, that way, the clinic is not having to call the prior authorization team and say, "Hey, is it ready yet? Is it ready yet? Is it ready yet?" So, if you have a standard turnaround time that you're promoting, and you can expect that prior authorization back the next day, or whatever that metric is for your center, you need to have that as your published standard. And if things are taking longer, reach out.