Health Equity & Access Weekly Roundup: September 25, 2026

NCCN Concordance Doesn't Guarantee Cancer Drug Coverage

Guideline concordance with the National Comprehensive Cancer Network (NCCN) is increasingly treated by payers as a floor for cancer drug coverage rather than a guarantee of it, according to panelists at The American Journal of Managed Care^®’s annual Patient-Centered Oncology Care® conference, held in Nashville, Tennessee, September 24-25, 2026. Terra Wonsettler, PharmD, MBA, of Evolent, said health plans that once covered treatment options through NCCN category 3 have narrowed coverage sharply, now frequently excluding category 2B regimens and, in some cases, reconsidering category 2A recommendations; Kiana Mehring, MBA, of Florida Cancer Specialists & Research Institute, said her practice measures its own regimens as 100% NCCN concordant, yet a study the group conducted with Avalere found that the leading reasons for prior authorization denials were noncoverage and step-edit requirements rather than clinical appropriateness. Tracy Spinks of Optum noted that UnitedHealthcare alone administers more than 30,000 separate employer formularies and benefit designs, and the panel pointed to a widening gap between the pace of guideline updates (481 over 8 months, per Spinks) and payer review cycles that typically take at least 4 weeks. Panelists called for electronic health record modernization, guidance that accounts for total cost of care, and greater financial transparency for patients and employers.

Overactive Bladder Predictors in Women Extend Beyond Age, BMI

Age, body mass index (BMI), household income, age at first menstruation, and vaginal delivery count emerged as the strongest predictors of overactive bladder (OAB) in US women, according to a machine learning analysis of National Health and Nutrition Examination Survey data published in JMIR Medical Informatics. Researchers benchmarked 11 algorithms across 7884 women from 4 survey cycles (2011-2018), and a random forest model performed best, achieving an area under the receiver operating characteristic curve of 0.8536 in the training set and 0.6999 in the test set; Shapley Additive Explanation analysis ranked age, BMI, and vaginal delivery count as the top 3 contributors, followed by systolic blood pressure, glycohemoglobin, income-to-poverty ratio, and age at first menstruation. The relationships were nonlinear: OAB risk rose sharply once BMI passed 33.659 kg/m2, in the class II obesity range, and climbed again once income-to-poverty ratio dropped below 3.299, a pattern the authors said aligns with economic strain delaying diagnosis. The authors positioned the model as a potential low-cost screening tool for community health and outpatient gynecology or urology settings, while acknowledging that the study's cross-sectional design cannot establish causality.

91% of Community Oncology Sites Offer Bispecifics Despite Barriers

More than 9 in 10 community oncology practices now administer bispecific T-cell engager (BiTE) therapy in-office, according to a survey of 104 respondents fielded by the Community Oncology Alliance in June and July 2026, with 91.4% of the 93 respondents who answered the question saying their practice currently administers bispecific therapy in-office and another 5.4% planning to within 12 months. Step-up dosing remained the most hospital-dependent phase of treatment, with only 35.1% of respondents initiating all ramp-up dosing in-office and 26.0% referring all patients elsewhere, most often because the product's package insert requires hospital-level monitoring, while maintenance dosing has largely shifted into the community setting (89.6% in-office). The leading barrier to building or sustaining a bispecific program was difficult or nonexistent care coordination with local hospitals for adverse event management, cited by 51.3% of respondents, followed by a lack of reimbursement for staff monitoring time (35.9%). Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group, said the infrastructure to deliver these therapies has not kept pace with their clinical advancement, comparing the situation to "driving a Ferrari on a road that hasn't been built yet," and respondents ranked additional reimbursement codes for monitoring time and clinical tools to ease staff burden as tied top priorities for improving program sustainability, each cited by 75.3% of respondents.

Medicare Part D Ruxolitinib Spending Hits $49.6 Million as Use Surges

Medicare Part D prescribing of topical ruxolitinib (Opzelura; Incyte) climbed from 5 clinicians nationwide in 2021 to more than 1000 by 2024, pushing annual program spending from about $256,000 to $49.6 million, according to a cross-sectional study of CMS Part D claims data published in JAAD International. Among dermatologists specifically, ruxolitinib's cost per day reached $68.76 in 2024, a 16-fold gap over generic tacrolimus ($4.29) and an 8.9-fold gap over generic pimecrolimus ($7.69), with prescribing concentrated in dermatology and dermatology-affiliated settings (54.9% of 2024 claims) and geographically concentrated as well, as New York and California together accounted for 56.0% of national claims that year. In pooled phase 3 trials, ruxolitinib achieved Investigator's Global Assessment success in about half of patients with atopic dermatitis, compared with roughly 37% near-clearance for tacrolimus, which the study authors said may justify a price premium for select patients even though the drugs are not direct clinical substitutes. Nanette Silverberg, MD, MPHc, of Mount Sinai, said that high up-front costs can offset the downstream expense of undertreating conditions like vitiligo, for which ruxolitinib has become a default first-line option despite frequent payer resistance, and the study authors called for continued surveillance as more topical Janus kinase (JAK) inhibitors reach the market.

Contributor: Congress Can Bring Mental Health Care to the 21st Century

Jesse M. Ehrenfeld, MD, MPH, and Ahmed Al-Katib, MD, argue that Congress should pass the Mental Health TALK SAFE Act of 2026 to permanently expand telepsychiatry access, citing projections that the US psychiatrist supply could shrink by roughly 20% by 2030, with more than half of counties nationwide already lacking a practicing psychiatrist. They point to a study that attempted to contact 948 psychiatrists across 5 states and found only 18.5% were accepting new patients, with a median wait time of 67 days for those able to secure an appointment, compared with a telehealth scheduling window of 0 to 14 days documented in a separate study, and estimate that untreated or undertreated mental illness costs the US economy about $282 billion annually through lost work and reduced participation. The bill, introduced in the House by Representative Neal Dunn (R, Florida), would make permanent the pandemic-era flexibility allowing qualified psychiatrists and psychiatric mental health nurse practitioners to prescribe controlled medications via telehealth (set to expire December 31, 2026), let licensed psychiatrists treat patients in other states via telehealth without a separate state license, and impose new federal guardrails on telehealth companies, including board-certified clinical leadership requirements, aimed at curbing business models tied to overprescribing.