Prior authorization: Patient involvement and time burden in cancer treatment.

175 Background: As cancer therapies grow increasingly complex, the burden of navigating insurance prior authorization (PA) has intensified for patients and families. Although healthcare teams (HCT) typically lead PA, patients may need to engage directly, including contacting insurers or pharmacies and filing appeals. We examined the frequency of patient involvement in PA, the time burden incurred, and factors associated with involvement. Methods: Adults with cancer were recruited from national survey panels for an online survey (Sept-Dec 2024) to evaluate PA experiences. Eligibility included: age ≥26, employer or Medicare insurance coverage, and treatment in past 12 months. Respondents reported if they underwent PA for each treatment type received, then answered questions about their most recent PA. We examined bivariate differences between PA involvement with sociodemographic background, clinical history, and insurance-related impacts using t and χ 2 tests, then estimated a multivariable logistic regression model predicting likelihood of patient involvement by correlates significant at the bivariate level. Results: Of 1201 eligible respondents completing the survey, 890 (74%) experienced PA between 2022-2024. They included women (59%); mean age 53 ( SD = 15); 71% non-Hispanic White, 13% non-Hispanic Black, 11% Hispanic. Top diagnoses: breast (32%), prostate (12%), hematologic (11%); median 2 years from diagnosis. Top treatments: 71% radiation, 65% IV chemotherapy, 63% immunotherapy. Insurance types: employer (55%), Medicare Advantage (31%), Traditional Medicare (14%). Half (50%; n = 444) reported direct involvement by self/family in their most recent PA; the remainder ( n = 446) said the HCT fully handled PA. Among those involved, 50% spent up to 1 business day (1-8 hours), 29% up to 2-3 days (9-24 hours), and 12% a full business week or more (41+ hours) on PA. Involvement differed ( p s < .05) for targeted therapy (73% involved vs. 27% HCT alone), supportive medications (64% vs. 36%); radiation (40% vs. 60%), and imaging (40% vs. 60%) at the bivariate level. Multivariable regression confirmed significantly greater odds of involvement for those < 65 with employer plans ( OR = 3.70) and those < 65 on Medicare ( OR = 2.06), compared to ≥65 on Medicare; for men ( OR = 2.12); for those with advanced disease ( OR = 2.06); and for those with delays in diagnosis ( OR = 1.66) or treatment ( OR = 1.54) due to PA; greater negative insurance-related impacts (physical, emotional, financial well-being; OR = 1.23); and greater cost-related medication scrimping ( OR = 1.21). Conclusions: Many people with cancer get directly involved in PA, often facing substantial time burdens. Involvement was most common among younger patients with employer plans and those with advanced disease, and associated with care delays and insurance-related hardship. There is an urgent need for PA reform to reduce burden and ensure timely, equitable access to cancer care.