Drug-Adjacent Advancements Directing Future Oncology Care: Abby Kim, PharmD

Expanding access and redefining drug access were central to the conversation on hot topics within oncology at the Academy of Managed Care Pharmacy in Nashville, TN.

Liquid biopsy, although not yet approved by the FDA, has already shown promise in the breast cancer space, panelist Abby Kim, PharmD, senior director of clinical strategy and oncology specialty solutions at Prime Therapeutics, said in an interview with The American Journal of Managed Care^® (AJMC^®).

In this Q&A, Kim dissects the real-world implications of introducing new oncology testing strategies to advance patient care.

This transcript was lightly edited for clarity.

AJMC: Liquid biopsy is expanding rapidly. How is it changing both early detection and access to targeted therapies from a payer perspective?

Kim: There's a lot of work and excitement going on there related to multi-cancer early detection testing using liquid biopsy to look for signals that someone might have cancer. This is beyond traditional screening and detection we have today with mammography or colonoscopy. This test is not yet FDA-approved as the science continues to evolve related to specificity and sensitivity, but I would expect that we may see some of this related to screening, detection, and liquid biopsy used in those forms, probably in the next year or so. I think there’s more to come on that, in terms of what that looks like and what patients will be eligible for testing, when it comes to thinking about liquid biopsy.

We're seeing a lot of movement with liquid biopsy in the breast cancer space, specifically related to looking at serial monitoring, testing every couple of months to look for certain mutations that have developed that we wouldn't normally be able to see until a patient showed clinical signs of progression on an image, and then we would test to see if that mutation developed.

I think there’s a lot of momentum going on in the space, and I think we can expect more information from the FDA, potentially guidelines, probably here in quarter 2026, to see what that is really going to look like to help get patients therapies earlier. We know in some studies the data is still pending there, but that's another area where the science is really maturing, as these are coming to market.

AJMC: With CAR T therapies moving into earlier lines and even solid tumors, how should managed care organizations rethink site-of-care strategies and coverage policies?

Kim: I think this is a super-hot topic that will evolve a ton over the next 3 years. And we talked about how over the last decade we've gained so much experience with CAR T therapy, and most academic centers that have been delivering it for 5 or 10 years really feel really comfortable with how they get patients access, how they deliver those therapies, and really importantly, how they manage toxicity, like cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. That’s become very protocolized as we've gained additional experience, and we've seen changes related to that with the FDA removing the risk evaluation and mitigation strategies criteria over the last year.

I think now we're moving into a new era where academic centers have become so comfortable in the inpatient setting that they're moving to the outpatient setting. That has opportunities and ramifications for different reimbursement structures—moving inpatient to outpatient. In addition, I think we see academic centers partnering with community centers as well to help prepare some of these community centers to deliver CAR T therapies so patients can stay closer to home and still have access.

Overall, I think that means potentially more eligible patients having access and willingness to receive CAR T therapies. I think we can expect additional claims coming in for CAR T, and I think we'll see additional CAR T therapies come to the market that are, potentially, more efficacious than more toxic. I think there’s going to be a lot of movement, especially on that side of the care space, over the next couple of years.

AJMC: As pharmacogenomic testing becomes more integrated, such as with fluoropyrimidine safety, how should payers incorporate this into formulary and utilization management decisions?

Kim: I think a lot of payers have actually been ahead of the guidelines and thinking about pharmacogenomic testing related to fluoropyrimidines like fluorouracil (5-FU) and capecitabine. They may have already had policies in place that require or mandate testing prior to the use of those therapies, not all, but some. But now, with the changes of the FDA label and the [National Comprehensive Cancer Network] guidelines, that really moved from consideration of testing in this pharmacogenomic area for fluoropyrimidines to a recommendation.

I think we can really expect that most provider groups will probably do universal testing, and payers can potentially expect more requests for those types of tests. And thinking a little bit about how pharmacogenomics testing in general has been a little bit slow to adopt, even though we understand the value of it. I think really taking a step back is when you receive a pharmacogenomic test for a patient who may go on 5-FU or capecitabine. Is there an opportunity for them to have other pharmacogenomic testing at the same time that might be the same cost to inform any future treatments that that patient might need as well? So I think there are lots of opportunities on this front.

AJMC: When you look across all these innovations—precision medicine, CAR T, digital navigation—how do you see them collectively shaping the future of oncology benefit design and patient access?

Kim: I think there's so much happening right now, and I think there's a lot happening outside of just the use of the drugs, but it’s still very drug-adjacent. When we think about biomarker testing, virtual navigation, or digital tools, they're very drug-adjacent. But these things are all starting to come together to think about how we, as payers, health plans, and pharmacy benefit managers, really care for that oncology patient holistically. And I think over the next few years, we'll see some of these become more interconnected to really improve care, but then also decrease spending.