Reimbursement

Latest News

August 27th 2025

CMMI Puts Early EOM Data Online, to Surprise of Participants

By Mary Caffrey

August 21st 2025

Employers Uncertain About Affording Employer-Sponsored Health Plans Within the Next 3 Years

By Julia Bonavitacola

August 20th 2025

Through AHIP, Payers Vow to Rein in Prior Authorization, but Doctors Have Doubts

By Mary Caffrey

August 19th 2025

The Untapped Potential of Principal Care Management in Oncology: Strategies to Drive Improved Performance and Outcomes

By Pallav Mehta, MD

August 19th 2025

PACE Program Expansion Requires For-Profit Investment, Reduced Regulatory Burden, and Greater Patient Eligibility

By Wayne Winegarden, PhD

Video Interviews

August 30th 2025

Eligibility Confusion, Constant Changes in Medicaid Could Leave Children Behind: Chris Johnson, MBA

August 29th 2025

Eligibility, Enrollment Potential Barriers to Children Receiving Medicaid After Cuts: Chris Johnson, MBA

July 10th 2025

RFK Jr Has Power to Remove USPSTF Members With Braidwood Decision: Jeffrey Fitzgerald, JD

July 7th 2025

Medina v Planned Parenthood Could Have Implications With Medicaid Funding: Jennifer Evans, JD

July 3rd 2025

Supreme Court Decision Marks a Failed Attempt at Attacking ACA: Jeffrey Fitzgerald, JD

July 2nd 2025

Medina v Planned Parenthood Case Reinterprets Any Willing Provider Provision: Jennifer Evans, JD

May 27th 2025

Oncology Advances Bring CAR T Local, but Community Practices Need Support: Nini Wu, MD

March 15th 2025

How Do Infusion Pharmacies Support Financial Sustainability in Oncology?

October 31st 2024

Legislation Can Help Increase Uptake of PDTs, Improve Reimbursement

October 20th 2024

EOM Improved Over OCM, but Challenges Remain for Practices

Podcasts

March 26th 2024

Exploring Medicare Advantage Prior Authorization Variations

August 1st 2023

Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology

More News

Alina Salganicoff | Image credit: KFF

August 8th 2025

Medicaid Cuts Have Far-Reaching Consequences in Women's Health: Alina Salganicoff, PhD

Julia Bonavitacola Alina Salganicoff, PhD

Alina Salganicoff, PhD, discusses the immediate effects of the budget cuts to Medicaid as it pertains to women's health across the country.

For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal

August 1st 2025

For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal

Proposed changes to the Physician Fee Schedule aim to support community oncology, but the Inflation Reduction Act threatens financial stability for practices.

PA form | Image: Adobe Stock

July 25th 2025

KFF Survey: Most Consumers Find Prior Authorization Is a Major Problem

A new survey reveals widespread consumer frustration with prior authorization, highlighting the need for urgent reform in insurance coverage.

Physician burnout | WaveBreakMediaMicro for Adobe

July 24th 2025

Commentary: Americans Can’t Afford to Lose Access to Their Doctors

Patients face increasing barriers to healthcare access as physician shortages rise and Medicare payment systems fail to support independent practices.

Planned Parenthood | Image credit: William A. Morgan - stock.adobe.com

July 23rd 2025

Supreme Court Case, Budget Bill Could Have Devastating Effects on Planned Parenthood: Q&A With Danika Severino Wynn, CNM

Julia Bonavitacola Danika Severino Wynn, CNM

The Supreme Court decision in Medina v Planned Parenthood South Atlantic and the subsequent passing of the budget bill leave Planned Parenthood clinics and their patients in a precarious spot, says Danika Severino Wynn, CNM.

Christine Pfaff, MBA, RPh | Image: LinkedIn

July 22nd 2025

COA Welcomes Christine Pfaff, MBA, RPh, to Leadership Team

Christine Pfaff, MBA, RPh, joins COA as director of clinical initiatives, enhancing support for community oncology practices and pharmacy operations amid health care challenges.

COA badge | Image: COA

July 15th 2025

For Community Oncology, Good News in PFS Offset by Potential Wreckage of MFP Proposal

CMS proposes the 2026 Physician Fee Schedule (PFS), addressing payment disparities in oncology, but the community oncology community warns of financial threats from the Inflation Reduction Act. Updates reflect late Tuesday release of the proposed 2026 schedule for the Hospital Outpatient Prospective Payment System.

Rise in drug pricing | Image Credit: Alex Puhovoy - stock.adobe.com

July 14th 2025

Medicare Inflation Rebates Show Limited Impact on Drug Price Trends

Brooke McCormick

Medicare inflation rebates fail to curb rising drug prices, highlighting the need for further policy action to control costs.

Image credit: Canva Illustration | Mary Caffrey

July 8th 2025

Practical Considerations for AI in Community Oncology

Artificial intelligence (AI) transforms oncology by enhancing decision-making, improving patient care, and streamlining operations, while addressing challenges in data accuracy and equity, said speakers at the Tennessee Oncology “Tech Innovations in Community Oncology."

Image credit: Canva Illustration by Mary Caffrey

July 7th 2025

How AI Can Address the Troubled Business Model in Oncology

Artificial intelligence (AI) will transform community oncology, addressing workforce shortages and reimbursement challenges while enhancing patient care and operational efficiency, discussed speakers at Tennessee Oncology's “Tech Innovations in Community Oncology."

Blood sample lab | Image credit: Caris Life Sciences

July 5th 2025

At ASCO, Testing and AI Rival Drugs for Attention, but Reimbursement Remains a Barrier

Precision oncology has entered a new phase, as data sets mature and a new wave of tools emerges to help clinicians manage cancer care over time.

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

June 30th 2025

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

Ted Okon, MBA, of the Community Oncology Alliance discusses how community oncology faces a revenue crisis due to the Inflation Reduction Act's impact on Medicare reimbursement, risking patient access to vital cancer treatments.

Planned Parenthood | Image credit: William A. Morgan - stock.adobe.com

June 26th 2025

SCOTUS Rules Abortion Clinics Can Not Challenge South Carolina’s Medicaid Order

Julia Bonavitacola

South Carolina had previously barred abortion clinics, including Planned Parenthood, from participating in Medicaid, leaving many patients vulnerable to uncovered treatment.

Image provided by NCCN

May 7th 2025

NCCN Summit Seeks to Build Better Connections Between Oncology and Primary Care

The National Comprehensive Cancer Network (NCCN) policy summit highlighted the need for improved communication between oncology and primary care to enhance cancer survivor outcomes and care transitions.

Patient navigation | Image credit: AON

April 22nd 2025

With Thyme Care Partnership, AON Achieves $6M in Savings in EOM’s First Performance Period

inflation reduction act | Image credit: Vitalii Vodolazskyi -stock.adobe.com

April 2nd 2025

The IRA’s Unintended Consequences for Drug Pricing and Coverage

Skylar Jeremias

The Inflation Reduction Act (IRA) may be restricting Medicare Part D formularies, increasing patient costs, and stifling pharmaceutical innovation, experts warned at the Academy of Managed Care Pharmacy 2025 annual meeting.

March 18th 2025

Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

Mary Caffrey Rose McNulty

Debra Patt, MD, PhD, MBA, executive vice president of Public Policy and Strategy for Texas Oncology, said the practice received positive feedback from nurses and patients during a pilot that concluded in February.

Kirollos Hanna, PharmD

January 29th 2025

Embracing EOM, Enhancing Collaboration and Cost Management: Dr Kirollos Hanna

Kyle Munz Kirollos Hanna, PharmD

The design of the Enhancing Oncology Model (EOM) was a perfect fit for Minnesota Oncology.

Class action book and gavel | Image credit: Zerbor – stock.adobe.com

November 5th 2024

GoodRx, PBMs Hit by Price Fixing Lawsuits

Hayden E. Klein

Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).

Screenshot of an interview with Stuart Staggs

October 27th 2024

The Challenge of Addressing Drug Spend to Drive Down Total Cost of Care in EOM

Laura Joszt, MA

Stuart Staggs, vice president of transformation and shared services at McKesson, explained that oncology practices in the Enhancing Oncology Model (EOM) have a tough job driving down costs when drug costs make up a larger portion of the total cost of care.

Stethoscope on money | Image credit: utah51 - adobe.stock.com

October 17th 2024

Pressure on Congress to Reform Medicare Physician Fee Schedule, Prevent Reimbursement Cuts

Laura Joszt, MA

A new letter signed by more than 230 members of the House urges Congress to not only block the scheduled 2.8% reimbursement cut, but also reform the Medicare Physician Fee Schedule.

October 14th 2024

The Daily Balancing Act of Value-Based Cancer Care

Laura Joszt, MA

Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

Doing Things Differently: Wilfong Moves to Thyme Care

Lalan Wilfong, MD, a 20-year medical oncologist with Texas Oncology, is senior vice president, value-based care, Thyme Care.

October 12th 2024

Beyond Navigation: Thyme Care Ready for Heavy Lifts to Make Value-Based Care Work

Stuart Staggs

September 27th 2024

EOM Adjustments Make it Easier for Practices to Say “Yes” to Participation

Laura Joszt, MA

After a small number of practices joined the Enhancing Oncology Model (EOM) in 2023, CMS has made some changes and opened the model back up for new practices to join.

AJMC

September 19th 2024

Care Transition Management and Patient Outcomes in Hospitalized Medicare Beneficiaries

Mariétou H. Ouayogodé, PhD Brianna Hardy, BS John Mullahy, PhD Maureen A. Smith, MD, PhD, MPH Ellen Meara, PhD

Hospital care transition activity facilitates uptake of Medicare-reimbursed transitional care management, which is associated with lower spending and better patient outcomes.

September 17th 2024

Part B Losses to Oncologists Due to IRA Could Total $12B Through 2032 Across Medicare, Commercial Plans

Based on an Avalere Health report, Community Oncology Alliance warns that IRA negotiations could slice down payments needed to administer cancer drugs.

Lalan Wilfong, MD, during a video interview

September 11th 2024

The Challenge of Living in Both FFS and Value-Based Care Worlds

Alexandra Gerlach Laura Joszt, MA

The transition to value-based care is extremely challenging because everyone is also still being paid by fee for service, said Lalan Wilfong, MD, senior vice president, value-based care, Thyme Care.

While shares varied by payer market, 73.6% of retail prescriptions overall were attributed to CVS Caremark, Optum Rx, and Express Scripts in the study. | Image credit: DedMityay - stock.adobe.c

September 10th 2024

A Highly Concentrated PBM Market Highlights Need for Policy Changes

The findings may help inform policy changes at the federal level aiming to address unfair and deceptive pharmacy benefit manager (PBM) practices.

Nick Ferreyros of Community Oncology Alliance during a video interview

September 10th 2024

IRA Negotiated Drug Prices Can’t Come “On the Backs of Providers”

Alexandra Gerlach Laura Joszt, MA

There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.

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