Health Equity & Access Weekly Roundup: July 10, 2026

Pharmacists Help Navigate Precision Lung Cancer Care: Stefanie Houseknecht, PharmD

Financial toxicity for patients on long-term targeted therapies for lung cancer has shifted from Medicare beneficiaries to commercially insured patients, according to Stefanie Houseknecht, PharmD, a clinical pharmacy specialist at Johns Hopkins Hospital speaking at the Institute for Value-Based Medicine® event in Washington, DC. Medicare beneficiaries once paid $800 to $900 per month out of pocket for oral targeted therapies for ALK-positive and EGFR-positive non-small cell lung cancer (NSCLC), a burden eased by the Inflation Reduction Act's Medicare Part D reforms; now, patients with employer-sponsored insurance increasingly struggle with complex pharmacy benefit manager (PBM) structures that shift more cost onto them as coverage narrows. Houseknecht said pharmacists and pharmacy technicians are positioned to bridge the gap between clinical teams, PBMs, and insurers, connecting patients with manufacturer co-pay assistance, foundations, and grants, while streamlining formulary choices and improving documentation ahead of insurance submissions to reduce denials and administrative burden.

Pediatric Cancer Creates Long-Term Financial Challenges for Patients, Families: Cherie Daly, MD

Financial toxicity in pediatric cancer extends well beyond the cost of medicine, according to Cherie Daly, MD, director of scientific affairs at the Pediatric Cancer Research Foundation. While institutions such as St. Jude Children's Research Hospital help cover treatment costs, Daly said nearly 40% of household income is typically lost when a parent leaves the workforce to care for a child with cancer full time, on top of costs tied to fertility preservation, sibling care, and mental health support, with long-term survivors, particularly those with brain tumors, facing lifelong disability, chronic organ damage, and lost future earning potential. She said financial hardship directly threatens treatment adherence, since pediatric cancer protocols often include extended maintenance phases that patients may abandon under financial strain, raising the risk of relapse and, in turn, greater long-term costs; she described the cumulative toll on families as a "snowball" and called for greater recognition of these nonmedical costs earlier in the treatment journey.

Easing Barriers to BTK Inhibitors in CLL: Kerry Rogers, MD

Financial toxicity tied to long-term Bruton tyrosine kinase (BTK) inhibitor therapy in chronic lymphocytic leukemia (CLL) is as much psychological as it is fiscal, Kerry Rogers, MD, of The Ohio State University Comprehensive Cancer Center—The James, said in an interview, noting that even patients with minimal out-of-pocket costs have questioned whether they are "worth" the price of therapy. She called financial toxicity a health system-level problem spanning drug pricing negotiation, government regulation, and reimbursement practices rather than something hematologists can solve alone, pointing to the American Society of Clinical Oncology's value framework, which found ibrutinib's efficacy and quality-of-life benefits made it the higher-value option despite its higher price than bendamustine/rituximab. On access, Rogers said oral BTK inhibitors, which can be mailed directly to patients, reduce geographic barriers compared with infusional regimens like venetoclax and obinutuzumab, and that manufacturer programs and Medicaid coverage have kept them financially accessible, sometimes more so than for commercially insured or Medicare patients; she also noted CLL trials underrepresent non-White populations relative to disease demographics and often exclude frail patients, citing new trials designed around higher comorbidity scores and a first-line pirtobrutinib study built to limit clinic visits for elderly enrollees.

Nonprofit, System-Affiliated Hospitals Lead in Multilingual Financial Assistance Access: Erin L. Duffy, PhD, MPH

Nonprofit and system-affiliated hospitals provide better access to financial assistance information in languages other than English compared with other hospital types, according to a study by Erin L. Duffy, PhD, MPH, a health policy researcher at the University of Southern California's Schaeffer Center for Health Policy & Economics, discussed on Managed Care Cast. Duffy's study, "Availability of Hospital Financial Assistance Documents in Non-English Languages," examined disparities in hospital financial assistance access across ownership types, and she previewed a related study slated for the July 2026 issue of The American Journal of Managed Care^® (AJMC^®) that builds on this work by evaluating the readability of these documents, extending the analysis from availability in multiple languages to whether patients can actually understand them once translated.

Reducing Coverage Barriers, Testing Delays Could Further Improve Lung Cancer Outcomes: Robert Kratzke, MD

Coverage denials for genomic testing in lung cancer have "essentially disappeared" at the University of Minnesota, according to Robert Kratzke, MD, a professor of medicine there, speaking with AJMC following a Minneapolis Institute for Value-Based Medicine event. Kratzke attributed much of the decline to Minnesota's biomarker testing mandate, effective January 2025, which requires state Medicaid to cover necessary genomic testing for patients with cancer; he has not seen a Medicare denial in about 5 years, and none in the past 2, and called for CMS to adopt a similar nationwide policy so that access to next-generation sequencing (NGS) does not depend on geography, comparing withheld biomarker testing to denying an X-ray for a broken bone. He also flagged turnaround time as a persistent barrier, noting nanopore microfluidic sequencing could return results in 24 to 48 hours, yet patients often wait 7 to 14 days, with Medicare's 14-day inpatient testing rule a particular obstacle, though his institution's reflex-testing model helps ensure sequencing data is ready by a patient's first oncology visit; he closed on an optimistic note, citing gains in stage 4 lung cancer survival from about 1 year historically to commonly 3 to 5 years today.