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If a practice's requests are approved almost every time, asking again wastes everyone's money; gold-card rules give such practices automatic approval and audit them instead.
Medicare Advantage insurers made nearly 53 million prior authorisation determinations in 2024 and overturned 80.7% of the denials that were appealed (KFF). Texas passed the first gold-card law in 2021: clinicians with approval rates above 90% are exempt from prior authorisation for those services. Oncology is well suited because on-pathway prescribing (NCCN categories 1 and 2A) is easy to audit retrospectively. Several insurers have announced gold-card programmes; making the rule statutory and pathway-based would extend it.
Shares NCCN Compendium and drug compendia, Not enough oncologists, nurses, pathologists, physicists, Fragmented care and guideline gaps.
Shares Not enough oncologists, nurses, pathologists, physicists, Fragmented care and guideline gaps.
Shares American Society of Clinical Oncology (ASCO), Not enough oncologists, nurses, pathologists, physicists.
Shares Incentives reward me-too drugs and marginal gains, Fragmented care and guideline gaps.
Shares American Society of Clinical Oncology (ASCO), Not enough oncologists, nurses, pathologists, physicists.
Shares American Society of Clinical Oncology (ASCO), Incentives reward me-too drugs and marginal gains.
Shares American Society of Clinical Oncology (ASCO), Incentives reward me-too drugs and marginal gains.
Shares American Society of Clinical Oncology (ASCO), Incentives reward me-too drugs and marginal gains.