Oncology

90 Million

Adults aged 65+ in U.S. population by 2050, vs. 46 million today

7 Million

Americans are battling cancer today; 1.9 million new diagnoses in 2023

50%

50% of cancer patients undergo radiation therapy.

“Balancing cost control with member satisfaction and fraud prevention requires robust oversight, streamlined processes, and clear communication to ensure plan integrity and positive member experiences.”

Challenges

Barriers to Prior Authorization of Oncology Treatments

One major challenge in medical oncology is how patients do not receive a treatment plan consistent with current medical evidence. The most common inconsistencies include

Costly Therapies Without Proven Advantage

Approving expensive treatments lacking robust evidence of superior outcomes leads to excessive costs without improved results.

Excessive treatment cycles or dosages

Authorizing unnecessary treatment cycles or dosages increases costs without adding value.

Missed Cost-Effective
Options

Failing to consider equally effective but affordable alternatives impacts plan sustainability.

Conquer Oncology PA Challenges with RISA

Rising cancer rates, complex treatment options, and opaque billing practices create a daunting landscape for payers. RISA simplifies your oncology PA process with robust oversight, streamlined workflows, and clear communication – ensuring cost control, fraud prevention, and member satisfaction.

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End-to-End Assistance

Comprehensive Coverage

Covering procedures, radiology, specialty drugs, and referral PAs—ensuring your needs are met comprehensively.

Diagnostics

Early diagnosis, timely approvals.
e.g., biopsies

Interventions

Improved outcomes, efficient approvals.
e.g., surgeries

Advanced Treatments

Innovative therapies, seamless approvals.
e.g., radiosurgery

Supportive Care

Quality of life, smooth approvals.
e.g., port placement

Advanced Imaging

Accurate diagnosis, cost-effective approvals.
e.g., PET scans

Tumor Imaging

Precise characterization, approvals based on clinical needs.
e.g., MRI

Metastasis Detection

Early detection, timely approvals.
e.g., bone scans

Screening & Early Detection

Saves lives, supports essential screenings.
e.g., mammography

Supportive Medications

Managing side effects, approvals for essential medications.

Hormonal and Oral Therapies

Individualized approvals for various cancers.

Immunotherapy & Advanced Treatments

Novel treatments, efficient approvals.

High-Cost Biologics & Gene Therapies

Informed decisions, accurate and timely reviews.

Specialist Consultations

Timely access to oncology specialists.

Support Services

Approvals for rehabilitation, nutrition, and psychology.

Innovative Treatments

Access to clinical trials and genetic counseling.

Multidisciplinary Care

Approvals for second opinions and team consultations.

Challenges

Prior Authorization Barriers to Oncology Treatments

72% of oral cancer meds need Prior Auth

Median delay in auth approvals: 1 Week

69% of cancer patients face care delays due to Prior Auth

Avg care delays in 33% of the cases: 1 Month

Financial implications for Oncology reimbursements

Annual expenditure per oncologist : $2-4Million

Complicated PA processes for new treatments

Initial PA denial rate for proton therapy: 42.8%

“A significant financial loss of $120,000 from a surgery I performed had to be absorbed due to an oversight in verifying the patient's coverage limits. The necessity for a precise and effective Prior Authorization solution has never been more critical.”

Dr. Ruchi Garg

National Program Director - Gyn Onc
City of Hope

Dr. Ruchi Garg

National Program Director - Gyn Onc
City of Hope

RISA’s intelligence streamlines
the Prior Auth journey

Accelerating access to treatments and easing financial pressures.
Our approach efficiently addresses insurance challenges, ensuring timely and quality patient care.

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End-to-End Assistance