Background: Oral targeted therapies in lung cancer represent a costly but critical component of care. Currently, the approval process for these treatments can sometimes take several weeks. Assessing the approval rates and efficacy of on-pathway treatment recommendations is an important step towards bringing clinicians and payors together to streamline the decision support and authorization process. Methods: We retrospectively analyzed authorization requests for oral anti-cancer agents for lung cancer. Eligible requests were filed between August 1, 2022, to March 1, 2024, and represented new treatment starts for that agent. In addition to collecting information about final authorization decisions, we determined whether the use case was consistent with Dana-Farber Pathways treatment recommendations in place at the time of the order. Furthermore, we measured survival from the start of oral therapy. Median survivals were calculated using the Kaplan-Meier method. These were assessed for the whole cohort and for each class of genomic aberrations. Results: There were a total of 214 eligible oral therapy claims filed between August 1, 2022, to March 1, 2024. 147 (69%) of these were considered on pathway, while 67 (31%) were off pathway. In total, 100% of the on-pathway navigations received payor approval, compared to 93% of the off-pathway navigations. The estimated 12-month survival was 86.5% for the on-pathway group, compared to 56.5% for the off-pathway group. Median overall survival has not yet been reached for either group. EGFR and ALK targeted therapies accounted for the majority of authorization requests, with 114 and 28, respectively. Conclusions: With the use of Dana-Farber Lung Cancer Pathways, the majority of requests for targeted therapies were consistent with pathway recommendations. This on-pathway cohort not only achieved a 100% payor authorization rate, but the 12-month survival was superior to that of off-pathway requests. These data provide a meaningful starting point for pathways vendors and healthcare payors to develop mutually agreed upon recommendations for use of these costly but impactful therapies.