Utilization management (UM) is a set of insurance practices used to control costs by managing when, how, and whether certain treatments are approved. But for people with cancer, these practices can cause more harm than help.
The Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management reveals the real-world impact of UM across different insurance types—Employer Plans, Medicare Advantage, and Traditional Medicare.
Drawing on a national survey of 1,201 people treated for cancer, the report shows that insurance red tape is widespread and can delay diagnosis and treatment, impose administrative burdens, lead to unexpected costs, and erode trust in the healthcare system.
Our report highlights how insurance red tape can impact people with cancer:
- 85% faced prior authorization for cancer treatments, 76% in the last year alone, often multiple times.
- 43% of Employer Plan respondents underwent prior authorization for five or more different types of cancer treatments in the last year.
- 29% reported diagnosis delays; 40% reported treatment delays due to authorizations.
- 14% experienced abrupt coverage stoppages in the past year; 64% of those experienced treatment interruption.
- Among those who dealt directly prior authorization, 51% lost up to a full business day, 27% lost up to 2-3 business days, and 12% lost a full business week or more dealing with a single authorization incident.
- 95% of prior authorization requests were ultimately approved, highlighting the inefficient and overly broad use of UM in cancer care.
- 36% reported worsened stress, 34% reported worsened finances, and 29% reported reduced trust in the healthcare system as a direct result of insurance problems.
- Respondents with Employer Plans reported the most administrative burden and greatest red tape impacts, followed by Medicare Advantage, then Traditional Medicare.
The results of this report make it clear that many people with cancer face insurance red tape and administrative inefficiencies that obstruct access to timely, high-quality care. UM and other cost-containment strategies must be designed to support, not delay or deny, affordable cancer treatment. Reforming these systems is essential to reducing burden in patients, improving outcomes, and ensuring that administrative processes facilitate, rather than hinder, care. Policymakers, insurers, employers, and advocates must collaborate to streamline UM processes, increase transparency, and prioritize person-centered care, allowing patients to focus on recovery, not red tape.
This report provides a robust, patient-informed snapshot of the current challenges in accessing cancer care. The findings can guide: policymakers seeking data to support insurance reform; insurers, pharmacy benefit managers, and payors aiming to improve coverage practices; employers evaluating benefit designs; researchers exploring the human impact of insurance barriers; and journalists reporting on healthcare access, policy and equity.
Media and Inquiries
A full media kit is available in addition to the Red Tape Report, Executive Summary, Impact Report and Red Tape: By the Numbers.
“Utilization management isn’t just red tape—it’s a treatment barrier. This report gives voice to people who have had to fight their way through the system to get the cancer care they need.”
— Dr. Alexandra Zaleta, Principal Investigator
Research Inquiries:
research@cancercare.org
Press Inquiries:
ashlosberg@cancercare.org
212-712-8323
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