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I read with great interest Dr. Lee Newcomer's recent editorial counterpoint regarding prior authorization (PA) reform, particularly in the context of cancer therapy ("The case against legislation on prior authorization," April 5, responding to "Don't let red tape burden patients," March 31). As a fellow medical oncologist, I appreciate the complexity of this issue but strongly disagree with several of Newcomer's points. As someone deeply embedded in the nuances of providing cancer care, I must emphasize that the current PA system is unsustainable and detrimental to patient care.

Newcomer rightly emphasizes the importance of correct therapy, highlighting the dire consequences of inappropriate treatment. However, his argument against the legislative exemption of cancer therapy from PA processes overlooks a critical reality: The timeliness of care is often just as crucial as the treatment choice itself. The delay inherent in PA can be detrimental, leading to the progression of disease, unnecessary suffering and, in some cases, death. The American Society of Clinical Oncology (ASCO) has consistently highlighted the adverse impact of delays in cancer treatment, underscoring that even short delays can significantly affect patient outcomes.

The examples provided by Newcomer, such as the misuse of erythropoietin and compliance with National Comprehensive Cancer Network (NCCN) guidelines, illustrate failures in the system that indeed require oversight and correction. While the National Comprehensive Cancer Network (NCCN) Guidelines serve as a valuable resource for oncologists, they are precisely that — guidelines. The complexity of cancer care means that not every patient's condition aligns neatly with these guidelines. There are numerous exceptions and clinical scenarios where deviation from standard guidelines is warranted and necessary. The rigid application of PA processes fails to accommodate the nuanced decisionmaking required in these cases, undermining the expertise of health care providers and potentially compromising patient care.

As a medical oncologist serving a rural community, I navigate a labyrinth of administrative processes that significantly delay critical care for my patients. Our small oncology practice must allocate substantial resources to manage these hurdles, employing a financial navigator and a dedicated full-time PA specialist. This allocation of human resources to administrative tasks detracts from direct patient care and is a luxury many rural practices can hardly afford.

The necessity for "peer-to-peer" telephone calls to justify treatment choices to insurance companies exemplifies the inefficiency and inadequacy of the current PA process. These calls are not only time-consuming but also introduce critical delays in initiating treatment. For cancer patients, time is often of the essence, and delays can significantly impact outcomes. The current system, designed to ensure appropriate care, frequently hampers our ability to provide timely, potentially lifesaving treatments.

The proposed legislation in Minnesota to exempt certain services, including cancer treatments complying with best practice guidelines, from PA requirements is a step in the right direction. As the debate on PA reform continues, I urge policymakers, insurers and stakeholders to consider the voices of patients, families and health care providers and the unique challenges we face. By doing so, we can work toward a health care system that prioritizes patient needs, respects professional judgment and ensures timely access to essential care for all Minnesotans.

Dr. Wade T. Swenson is a medical oncologist and hematologist in Staples, Minn.