A man with leukemia wrestles with his insurance company for access to medications to manage his excruciating pain. An oncologist is forced to delay needed treatments while arguing for health insurance approval for weeks. Increasingly, doctors attempting to get their patients necessary medications, devices and procedures find their efforts stymied by a labyrinth of "prior authorization" hurdles created by insurance companies.

Dr. Fumiko Chino, a treating oncologist at MD Anderson Cancer Center and researcher in financial impact of cancer care, and Dr. Nathan Gray, a palliative care physician at Johns Hopkins University School of Medicine and illustrator who uses art to address medical topics, collaborated on this opinion column about the complications and harms caused by the growing demands of prior authorization in medicine.

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In their graphic narrative, they tell the story of one of Dr. Gray's patients, James Yager, and his struggle to get pain relief in his final days. For both patients and providers, prior authorization can feel like an unfair game they are designed to lose.

Dr. Fumiko Chino is a treating oncologist at MD Anderson Cancer Center. Dr. Nathan Gray is a palliative care physician at Johns Hopkins University School of Medicine and an illustrator: @inkvessel

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