News|Articles|September 24, 2026

91% of Community Oncology Sites Offer Bispecifics Despite Barriers

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Key Takeaways

In-office bispecific administration is near-universal in independent community oncology.
Ramp-up dosing shows mixed site-of-care patterns, with hospital referral frequently dictated by package-insert monitoring requirements and also influenced by comorbidity risk stratification and payer limitations.
Sustainability hinges on reimbursement modernization for staff monitoring time, deployment of clinical tools to reduce workload, improved payer coverage, and broader dissemination of standardized protocols and SOPs.

Most community oncology practices now administer bispecific antibodies in-office, but reimbursement gaps remain a top barrier, a survey finds.

Nearly all community oncology practices surveyed by the Community Oncology Alliance (COA) are now administering bispecific antibody therapy in-office, but reimbursement gaps and hospital coordination challenges remain the biggest obstacles to building and sustaining these programs, according to new survey data from the organization.¹

The COA BiTE (bispecific T-cell engager) Survey went out to COA's Board of Directors, the Community Oncology Pharmacy Association, and the Community Oncology Administrators' Network over 4 weeks in June and July 2026. The survey drew 104 responses, 97 of whom identified as working at an independent community oncology practice. Respondents included practice administrators, pharmacists, nurses, advanced practice providers, physicians, and revenue cycle and value-based care leaders spanning more than 25 states.

How Common Is In-Office Bispecific Administration?

Of the 93 respondents who answered the question, 91.4% said their practice currently administers bispecific therapy in-office, while another 5.4% said they were planning to do so within 12 months. Only 2.2% had no plans to offer the therapy.

Among the 90 respondents who specified which products their physicians prescribe, 96.7% reported prescribing bispecifics indicated for hematologic malignancies such as lymphoma and myeloma, and 93.3% reported prescribing bispecifics for solid tumors such as lung cancer. More than a third (38.9%) also reported prescribing investigational bispecific products through clinical trials.

The findings track with the broader trend seen in the past year, as bispecific antibodies move from academic medical centers into community-based care.² Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group, has described the shift as requiring a fundamental operational overhaul, not just clinical buy-in.³

How Practices Handle Step-Up Dosing

Step-up, or ramp-up, dosing at the start of bispecific therapy remains the most hospital-dependent phase of treatment.¹ Among 77 respondents, 35.1% said they initiate all ramp-up dosing in-office, while 37.7% said they selectively refer patients to a hospital or academic medical center depending on patient characteristics; 26.0% refer all patients for ramp-up dosing.

When practices do refer patients elsewhere for ramp-up dosing, the leading reason, cited by 54.4% of the 79 respondents to that question, was that the product's package insert requires hospital monitoring. Patient comorbidities and insurance restrictions were each cited by 24.1% of respondents, while a hospital relationship driving the referral was cited by just 5.1%.

By contrast, maintenance dosing after ramp-up has largely moved into the community setting: 89.6% of 77 respondents said they administer all maintenance dosing in-office, and no respondents said patients continue maintenance dosing exclusively at a hospital or academic medical center. Among practices that do refer some patients for maintenance dosing, continued high risk for cytokine release syndrome or immune effector cell–associated neurotoxicity syndrome was the top clinical reason, cited by 16.9% of respondents.

What's Holding Community Bispecific Programs Back?

When asked about barriers to starting or maintaining an in-office bispecific program, 51.3% of 78 respondents pointed to difficult or nonexistent coordination of care with local hospitals for adverse event management, the most common reported barrier. More than a third (35.9%) cited a lack of reimbursement for staff monitoring time, and 28.2% said patient monitoring requirements are too time-intensive for their staff. Smaller shares cited physician or advanced practice provider discomfort taking calls for bispecific patients (25.6%), staff hesitancy around adverse events (24.4%), prior authorization delays (23.1%), and underwater reimbursement (16.7%).

These findings echo concerns directly from community oncology pharmacy and operations leaders throughout 2026, who have described step-up dosing coordination as “resource extensive” and warned that reimbursement has not kept pace with the staffing demands bispecifics require.⁴ Ajayi referenced a phrase from Debra Patt, MD, PhD, MBA, MPH, executive vice president of policy and strategic initiatives at Texas Oncology, who has likened the situation to driving a Ferrari on a road that hasn’t been built yet.⁵

“You have really advanced treatments, but the path to the delivery of these treatments is really not well advanced,” said Ajayi, who is also the moderator of The American Journal of Managed Care^®’s Bispecifics Network for 2026. “Making sure we have very good workflows [and] making sure we have the right education for the right team is going to be really key.”

When asked what would help most in building and maintaining a bispecific program, respondents ranked additional reimbursement codes covering staff monitoring time and clinical tools to ease staff burden as tied top priorities, each cited by 75.3% of 77 respondents.¹ Advocacy for fair payer coverage and reimbursement followed at 59.7%, and operational guidance or SOP-sharing among community practices was cited by 55.8%.

In open-ended responses, practice staff across departments echoed a similar refrain: billing and reimbursement structures have not caught up with the time-intensive, complex monitoring that bispecific therapy requires, and many pointed to a need for standardized protocols and peer-to-peer learning to ease implementation. One pharmacy respondent noted that “consensus guidelines from a national organization would have made the program so much easier to implement.”

The results add to a growing body of evidence that community oncology has moved past the early-adoption phase for bispecific antibodies and is now grappling with how to make delivery financially and operationally sustainable at scale, as more products move into earlier lines of therapy and eligible patient populations grow.²

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