Payer Decision Making

From Denial to Access: Rethinking Oncology Care Through AI, Clinical Trials, and Patient-Centered Innovation

The rapid expansion of precision medicine, biologics, and targeted cancer therapies is transforming oncology—but it’s also overwhelming a system not built to keep pace. In the U.S., cancer drugs now account for some of the highest-cost treatments in healthcare, and with that has come a surge in prior authorization requirements and denials. Studies suggest physicians…

Navigating Payer Denials: A Physician Advisor’s Perspective #2

A physician advisor recently described a case that should unsettle anyone who cares about fair, clinically grounded coverage decisions: a Medicaid patient arrived comatose from an overdose, was emergently intubated, developed aspiration pneumonia, and stayed through three midnights before leaving against medical advice. By any bedside standard, this is acute, unstable care—exactly what…