Community Bispecifics Success Hinges on Education, Reimbursement

Successfully administering bispecific therapies in community oncology settings hinges on solving a web of operational challenges, such as staff education and standardized communication, to ensure adequate reimbursement. Those gaps will only grow more urgent as bispecifics move into earlier lines of therapy, according to Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group and moderator of The American Journal of Managed Care^®’s (AJMC^®) Bispecifics Network for 2026.

What a Successful Community Bispecifics Program Looks Like

The primary goal of community-based bispecific administration is straightforward: keeping patients close to home. But achieving that goal is anything but simple. Ajayi outlined 3 foundational pillars that practices must have in place before they can deliver these therapies safely and sustainably.

The first is education. Clinicians administering bispecifics and those monitoring patients afterward must be trained not only to recognize adverse events but also to anticipate them.

"Having a very good education program is extremely important," Ajayi said. Without it, the clinical risks of these high-acuity therapies cannot be managed responsibly in an outpatient setting.

The second pillar is standardized communication. Bispecific administration often involves coordination between clinic and hospital teams, making a shared language across care settings essential to avoiding gaps in patient monitoring and handoffs.

The third is reimbursement. Practices absorbing the financial risk of dispensing high-cost agents need assurance that they will be paid appropriately. Without a viable reimbursement structure, the business case for community-based bispecific programs remains precarious.

Infrastructure Gaps Will Widen as Bispecifics Move Earlier

As bispecific therapies move into earlier lines of treatment, the eligible patient population will grow larger, and the infrastructure shortfalls already straining community practices will become more acute. Ajayi flagged workforce capacity as a particular concern, emphasizing the need for enough providers who can triage and respond to patient needs in real time.

He borrowed a phrase from Debra Patt, MD, executive vice president of policy and strategic initiatives at Texas Oncology and a past president of the Community Oncology Alliance, to capture the central tension: these treatments are like Ferraris driving on roads that haven't been built yet.

“You have really advanced treatments, but the path to the delivery of these treatments is really not well advanced,” Ajayi said. “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.”

Ajayi will continue to address these operational questions throughout 2026 as part of AJMC's Bispecifics Network.