© 2025 MJH Life Sciences™ and CURE - Oncology & Cancer News for Patients & Caregivers. All rights reserved.
Ryan Scott is an Associate Editor of CURE; she joined MJH Life Sciences in 2021. In addition to writing and editing timely news and article coverage, she manages CURE's social media accounts; check us out @curetoday across platforms such as LinkedIn, Facebook, X, and Instagram! She also attends conferences live and virtually to conduct video interviews and produce written coverage. Email: rscott@mjhlifesciences.
Dr. Alexandra Zaleta discussed actionable steps that individuals can take to advocate for a more person-centered insurance practice approach.
Although it is another heavy burden to carry when already grappling with you or your loved ones cancer diagnosis, self-advocacy is vital in driving change toward more patient-centered insurance practices, Dr. Alexandra Zaleta emphasized, acknowledging that navigating the system can feel overwhelming, but ensuring that there are support resources.
“I know it's a lot to ask people who are already facing cancer, fighting cancer, or supporting their loved ones to take on one more thing. However, it's that collective strength that will help us make the necessary changes to our healthcare system and address this insurance red tape,” Zaleta emphasized in an interview with CURE.
In the interview, she breaks down actionable steps that individuals can take to advocate for themselves and their loved ones for a more person-centered insurance practice approach.
To hear more from our conversation with Zaleta, and to learn about insurance-related obstacles and ways to advocate for yourself, explore her other CURE articles: “The Emotional Impact of Insurance Delays for Those With Cancer” and “The Hidden Cost of Cancer: Time Toxicities and Insurance Delays.”
Zaleta: Well, we all have a role to play here, and that's been my number one lesson. I'm a researcher and a psychologist. I also used to be a caregiver to my father for many years. I once thought only policymakers could solve this problem, but now I realize we all have a role and a responsibility: patients, caregivers, families, clinicians, policymakers, and employers. We're not going to do it alone.
Patients and caregivers have many options for communicating with their doctors, employers, and lawmakers. We understand that this can be a scary or confusing prospect, which is why I strongly encourage people to reach out to a support source like CancerCare. We have our toll-free hope line where they can call and speak to an oncology social worker. They can also sign up for our e-newsletter. There are ways for them to find out, and we can help support people in understanding how they can engage with and talk to these different sources. This [support] ensures their voice is heard, and that their employer and lawmakers understand their story, because their stories are what will help create change.
It's so important, and I know it's a lot to ask people who are already facing cancer, fighting cancer, or supporting their loved ones to take on one more thing. However, it's that collective strength that will help us make the necessary changes to our healthcare system and address this insurance red tape.
I think there are really two key issues here. Do we truly need to require prior authorization for all these aspects of cancer care? Is this the necessary default for every type of cancer treatment? We observed that no treatment or procedure was spared, whether it was imaging, biomarker testing to determine the best options, chemotherapy, radiation therapy, or even supportive medications for pain or nausea.
For the vast majority of people, these things were undergoing prior authorization before they could receive care. So, I believe we need to take an honest look: does this truly need to be the default, checking the medical necessity and appropriateness for all these elements, especially when we know 95% of them were ultimately approved? To me, that equation doesn't add up, and it suggests an overly broad reach and overextension of where prior authorization is being applied.
Another piece is improving the process itself. If there are situations that genuinely require prior authorization, how can we make it more efficient so that approvals turn around in days, not weeks or months? The process also needs to be truly transparent so that patients and providers know what to expect. This way, when prior authorization does need to happen, it can occur very efficiently without creating the diagnostic and treatment delays we're currently seeing. For certain types of care, every day and every week matters; when that care is delayed, it has a meaningful impact on people's outcomes. Therefore, we must eliminate those delays and make the process more efficient.
I truly meant what I said earlier, and I want to be very clear: everyone has a role to play in this space. Insurers and pharmacy benefit managers have essential accountability here. Employers have essential accountability here. And then patients, caregivers, clinicians, and advocates—we all have a continuing role to play, to share these stories, and to advocate and work together with all these other stakeholders, including policymakers and everyone else, to try and create this change. It has to happen broadly, and it has to happen with a collective voice to truly make this work.
One more crucial point is that patients experience these delays, not only before starting treatment, but also while already undergoing existing treatments. We had folks whose insurance companies come in and say, “We're no longer covering the care that you're currently receiving.” We found that almost one in five individuals reported their insurance companies suddenly ceased covering their ongoing care. This wasn't due to a change in insurers or jobs, which is a separate but important issue. Instead, it happened because insurance companies changed their criteria for medical necessity or altered a drug's tier.
This is incredibly frightening for patients. They've already fought to get their initial approval, they're receiving their care, and then they find out their current treatment is no longer covered. Unsurprisingly, for many, this led to interruptions in their treatment. Some individuals ended up having to switch treatments, and when they did, they often experienced worse side effects, and sometimes the new treatment cost them more rather than less. This is another significant problem, where a process intended to save costs and lead to better outcomes often isn't helping people with cancer.
I wanted to highlight this other facet because while prior authorization is a huge and widespread issue, the treatment interruptions and loss of coverage for existing treatments are truly terrifying for those affected. We need to closely examine this to ensure that once someone's care is covered, they don't experience a sudden loss of coverage from their current insurer.
“The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management” by CancerCare. 2025 Red Tape Report by CancerCare.
For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
Related Content: