Payers

Advanced therapies are pressuring reimbursement and necessitating real-world durability data and new payment models, said Fran Gregory, PharmD.

Policy experts discuss how PBM reforms came together, what changes are on the horizon, and what threats are looming for community oncology.

Bringing these curative treatments to more patients means making them available at the community practice level. But that's a big lift, according to experts who spoke at a COA session.

As physician shortages and burnout threaten the patient experience in oncology, The US Oncology Network works to scale solutions, including the use AI ambient scribes and other workflow fixes, as well as fostering self-care strategies.

At NAACOS 2026, value-based care leaders make the case for treating payers as partners and explain what providers must see in return.

FDA grants lunsotogene parvec-cwha approval for OTOF-related hearing loss, delivering single-dose gene therapy gains and expanding access with free US supply.

A new AHIP report outlines evidence-based strategies to cut chronic disease prevalence by 10% by 2035.

LaShawn McIver, MD, MPH, discusses a new report from a task force aiming to cut chronic disease prevalence 10% by 2035 through prevention and coordinated care.

During an afternoon AMCP 2026 session, experts called for integrated clinical and payer care models to combat rising metabolic disease prevalence, costs, and complexity.

Todd Doyle, MD, of OneOncology, warns that commercial payers lag on updating bundled codes, which has slashed radiation oncology revenue and risks community cancer access in 2026.

Prior authorization and PBM utilization management delay oncology and hematology novel therapies, shifting reimbursement risk to patients in Medicare Advantage.

Tim Church, MD, PhD, MPH, explains that access to care—not willpower—is the central barrier to GLP-1 use, and says employer coverage decisions are finally catching up.

A phase 1 clinical trial specialist, Nancy L. Lewis, MD, MBS, FACP, most recently spent more than a decade at Novartis and was previously a faculty member at Fox Chase Cancer Center and Thomas Jefferson University Hospital.

ACIP changes threaten vaccine coverage and raise costs, according to a roundtable of experts warning of widening disparities and long-term public health risks.

The law stems from the case of a beneficiary of the state workers health plan, repeatedly denied an alternative cancer treatment, only to be approved after he was too ill to be a candidate.

The study covers the period of 2015-2019 in Germany, before approvals for CAR T-cell therapy, pirtobrutinib, and the arrival of less toxic BTK inhibitors.

Rapid genetic test for IVF identifies FSHR variant in 60 minutes, guiding IVF hormone selection and improving in vitro fertilization success.

Real-world evidence shows Pluvicto matches pivotal trial benefits in PSMA-positive mCRPC, with longer PFS after an androgen receptor pathway inhibitor.

Genmab’s epcoritamab (Epkinly) streamlines bispecific antibody workflows for DLBCL and follicular lymphoma, cutting chair time, waste, and costs.

Scripta allows consumers to compare prescription prices, coupons, and insurance options in one place, helping patients and employers find affordable meds and smarter choices.

340B covered entities are expanding contracts with retail pharmacies that are increasingly located in counties with high rates of Medicare and Medicaid insurance coverage.

New GLP-1 pills challenge injections as competition, and discussions of possible Medicare coverage could push prices down.

Reform priorities aim to reshape PBM oversight, delink compensation from drug prices, boost transparency, and protect pharmacy access.

Ameet Patel, MD, concludes by outlining strategies to overcome operational, financial, and payer challenges in delivering advanced multiple myeloma therapies.

Catherine Gaffigan, MD, Elevance Health's President of Health Solutions, discusses value-based care initiatives and payer-provider relationships.