Oncology Leaders Address Testing, Access, Equity, and Pharmacy in Cancer Care

On the heels of transformative advances in targeted therapy, biomarker-driven treatment selection, and novel cellular therapies, oncology care increasingly demands that clinical excellence be matched by operational precision from the laboratory to the pharmacy to the communities in which patients live. Ensuring these innovations reach all patients equitably and that the systems supporting them are efficient and financially sustainable has become a defining challenge for health systems.

To address these intersecting imperatives, The American Journal of Managed Care^® convened leading oncologists, hematologists, pharmacists, and health system administrators from Chicago’s major academic medical centers on March 12, 2026, for the Institute for Value-Based Medicine^® event, “Pioneering the Next Era of Oncology Care.”

Precision in Practice: Implementing Biomarker Testing in Lung Cancer

The opening panel, moderated by Frank Weinberg, MD, PhD, thoracic oncologist and director of the thoracic oncology program at the University of Illinois College of Medicine (UICM), discussed comprehensive molecular profiling. Panelists agreed that biomarker testing in lung cancer has transcended its historic association with advanced disease and should now be applied at every stage, given the expanding role of targeted therapies in the early-stage setting.

Ryan Nguyen, DO, assistant professor of clinical medicine and precision oncology program lead at UICM, made the case for universal testing from the outset. “You can make an argument that broad-based molecular testing is necessary at every stage now, especially since we have clinical trials that have biomarker enrollment criteria even at the earlier stages,” he said, adding that this workflow reduces the risk of patients slipping through institutional cracks.

Koosha Paydary, MD, a medical oncologist at Rush University Medical Center (Rush), underscored the clinical consequences of gaps in testing. Real-world data published in JAMA Network Open show that less than 60% of patients undergoing perioperative chemoimmunotherapy for non–small cell lung cancer (NSCLC) had EGFR testing completed, despite evidence that patients with EGFR and ALK alterations derive limited benefit from immunotherapy.¹ Paydary also emphasized that the RNA fusion panel is a frequently overlooked component but added that many molecular tests ordered nationally lack an RNA fusion panel, which is an important gap.

Young Kwang Chae, MD, MPH, MBA, a professor of medicine in hematology and oncology at Northwestern University Feinberg School of Medicine (Feinberg), welcomed the framing of “timely testing” rather than “reflex testing” to describe the operational standard institutions should aim for. “It is definitely a moving target, but we are moving in the right direction,” he said of the expanding role of targeted kinase inhibitors in early-stage NSCLC, “and it is definitely absolutely necessary to get the full-spectrum next-generation sequencing ready for all these early-stage patients.”

The panel also addressed the role of liquid biopsy as a complementary tool. Nguyen described simultaneous tissue and liquid submissions for new stage IV diagnoses as standard practice at UICM given that “time is really of the essence.” He also noted that liquid biopsy results have, on occasion, preceded pathology confirmation. In the second-line setting, where rebiopsy timelines can stretch to a month, liquid biopsy results returning in 5 to 7 days can drive meaningful treatment decisions around resistance mechanisms.

Operationally, the panelists described a spectrum of institutional readiness. Nguyen contrasted the experience at UICM where molecular testing has been integrated into the electronic health record (EHR), reducing order time to under 2 minutes, with Cook County Health, where the absence of EHR integration can extend the same process to 7 to 10 minutes per patient. This time “adds up and leads to a lot of complications.” Chae noted that Northwestern’s in-house sequencing platform yields results within 7 to 14 days for lung biopsies that enter through a standardized tumor board workflow, although biopsies from nonlung sites remain a gap.

Illinois House Bill 1779, which mandates that state-regulated health plans and Medicaid cover biomarker testing supported by medical evidence, was cited as a meaningful policy advance. However, the so-called 14-day rule, which requires a 14-day period from hospital discharge before molecular testing can be initiated for inpatient diagnoses, still represents a significant access gap for the highest-acuity patients who need results fastest. “You create this rule that actually leads to worse care for the patients who are most in need,” Nguyen said of inpatients with stage IV disease who require immediate treatment decisions. Work-arounds such as initiating liquid biopsy in the inpatient setting and clarifying that the 14-day clock begins at the time of order, rather than the time of testing, are being actively explored.

Improving Access to Care for Hematologic Malignancies

The second panel, moderated by Guru Murthy, MD, MS, an associate professor in the Division of Hematology and Oncology at the Medical College of Wisconsin in Milwaukee, examined the diagnostic, logistical, and financial barriers that shape access to care in hematologic cancers.

Xinyan Lu, MD, FACMG, medical director of the clinical cytogenetics laboratory and professor of pathology at Feinberg and the Robert H. Lurie Comprehensive Cancer Center, illustrated the diagnostic complexity from the laboratory’s perspective. She noted that her team receives approximately 50 samples daily and that incomplete clinical indications on requisitions can result in diagnostic delays. “Close communication is the key,” she emphasized, describing the proactive outreach her team maintains with ordering providers to prevent such errors and ensure the right tests are performed on the right samples.

Regarding artificial intelligence (AI), Lu noted that her laboratory is participating in an international working group exploring AI-assisted interpretation of comprehensive sequencing panels. This approach is also being used for fusion gene identification, where the clinical significance of individual fusions remains difficult to ascertain.

Matías Sánchez, MD, an assistant professor in the Department of Medicine in the Division of Hematology and Oncology at UICM, described the challenge of broadly implementing minimal residual disease (MRD) testing in multiple myeloma. He noted that community-referred patients frequently arrive without pre- and posttransplant MRD assessments despite coverage by Medicaid for more than 1 test annually. He also highlighted the reimbursement gap around TP53 mutation testing in myeloma, which requires ordering a full myeloid panel—a process that is often not covered despite National Comprehensive Cancer Network guideline support.

The panel also addressed the access implications of advanced therapies such as chimeric antigen receptor (CAR) T-cell therapy. For Medicaid-insured patients seeking CAR T-cell therapy, Sánchez described a 2-month approval process requiring letters of medical necessity, with uninsured patients in Cook County effectively excluded from both transplant and CAR T-cell options. Many patients have shifted to bispecific antibodies—not due to clinical preference but because they lack the caregiver infrastructure required for CAR T-cell therapy administration. “Many patients have chosen bispecifics instead of CAR T-cell therapy just because they don’t have a caregiver,” Sánchez noted, pointing to a social determinant that existing coverage frameworks have yet to address.

The panel closed with a discussion of challenges stemming from the immediate release of genomic results in patient portals. Lu described how premature patient access to complex genetic reports (ie, before a clinician has reviewed and contextualized findings) can generate significant confusion and anxiety. She advocated for institutional policies that allow physicians to review results first and noted that Northwestern has established agreements with reference laboratories to route results through the treating physician rather than directly to the patient.

Closing the Gap: Advancing Equity in Cancer Care

The next panel, moderated by Nan Sethakorn, MD, PhD, a thoracic medical oncologist at Loyola University Chicago, examined cancer screening disparities, patient navigation, clinical trial diversity, and financial toxicity. The panelists examined these dimensions of the broader equity challenge facing oncology practices across the Chicago metropolitan area.

Mohamad Khasawneh, MD, a hematologist-oncologist at Loyola, opened with a data-anchored overview of screening trends. Although most cancer screening rates have returned to prepandemic baselines for commercially insured patients, lung cancer retains the lowest screening uptake of any cancer type, and disparities persist among rural communities, urban underserved populations, and African American patients.² He also noted that cervical cancer screening remains a long-standing area of unmet need that existed even prior to the COVID-19 pandemic.

Nan Chen, MD, a breast medical oncologist at University of Chicago Medicine, spoke to the limitations of mobile mammography as an outreach strategy, noting that the university’s experience revealed a fundamental gap: Patients who were screened but could not be retained through biopsy and follow-up had not truly benefited. “Cancer navigation is so incredibly important, and I’ve seen so many patients fall through the cracks,” she said, describing the university’s model of dedicated breast navigators who initiate contact at the time of a positive biopsy and maintain continuity across care transitions.

Anil Saldanha, MS, chief innovation officer at Rush, provided a systems-level perspective rooted in Rush’s longitudinal work on health disparities in Chicago. He referenced research demonstrating “Chicago’s death gap,” a 16-year life expectancy gap between residents of the Michigan Avenue corridor and those living 4 subway stops to the west. The research found that cancer was a big contributor to this disparity.³ Rush has responded by building coalitions with community-based organizations, faith-based groups, and like-minded health systems and by embedding community health workers and language interpreters to reduce structural barriers to screening and care. He described a tablet-based social determinants of health screening tool piloted for lung cancer eligibility identification, which has since been incorporated into the forthcoming Sankofa Wellness Center on Chicago’s West Side.

The panel engaged substantively on financial toxicity and clinical trial diversity. Chen identified provider bias as a primary barrier to minority enrollment. “In terms of minority populations, if you ask patients to participate, they are just as likely to say yes,” Chen noted, “and so I think the first thing is recognizing provider bias.” Material barriers that remain include things like transportation, childcare, time away from work, and the burden of additional clinic visits. Industry sponsors have begun addressing these issues through visit stipends and parking reimbursements, but the panelists agreed that trial protocols themselves must be simplified to meaningfully expand access. Khasawneh added that framing trial participation as part of standard care rather than as an exceptional ask can reduce cultural hesitancy and that informing patients that current therapies exist because past participants enrolled is compelling.

Pharmacy at the Helm: Medically Integrated Dispensing in Oncology

The evening’s final session, moderated by Charlene Hope, PharmD, MS, CPHQ, CPPS, chief pharmacy quality and medication safety officer at University of Chicago Medicine, examined how medically integrated dispensing (MID) models in oncology, in which specialty pharmacy services are embedded within the institution rather than outsourced, improve adherence, reduce financial barriers, and enhance patient safety.

Sandra Cuellar, PharmD, BCOP, FHOPA, FASHP, a clinical oncology pharmacist, clinical associate professor, and director of the oncology residency program at University of Ilinois at Chicago College of Pharmacy, offered a practical definition. She explained that MID means a pharmacy embedded within the institution is able to dispense high-cost specialty medications directly to patients, eliminating reliance on external specialty pharmacies and the fragmented communication that accompanies them. She illustrated the value with a real-time example: Immediately before the event, she identified via Epic chat that a patient had been prescribed a compounded mouthwash for mucositis at an external pharmacy for $155, which was an amount the patient could not afford. By looping in the UIC in-house pharmacy, she arranged for an equivalent compound priced at $40. “That’s the value of integrating a clinical pharmacist,” she said, noting that the pharmacist’s familiarity with the patient’s treatment history also allowed her to flag that the original formulation was clinically inappropriate given the patient’s PI3K inhibitor exposure.

Matthew Rim, PharmD, MS, FASHP, chief pharmacy officer at Northwestern Medicine, described the operational infrastructure that enables this model to scale. Northwestern’s internal specialty pharmacy team manages prior authorizations (PAs), with a median turnaround of 2 business days. This turnaround is down from 3 to 4 days following AI integration into the PA workflow, representing approximately a 50% efficiency gain. Even when pharmacy benefit manager contracts require transfer to an external specialty pharmacy, the institution’s team still facilitates the PA and coordinates the handoff to prevent care delays.

Mildred Carino, PharmD, BCOP, manager of cancer ambulatory pharmacy services at Rush, described a day-in-the-life workflow in which pharmacy technicians, subspecialized by disease state, receive prescriptions, process test claims, initiate PA, identify co-pay assistance eligibility, and follow up with patients at 30- and 60-day intervals. She noted that guidelines support MID models as a way to optimize adherence and reduce dose delays caused by toxicity. These outcomes are driven by the subspecialized pharmacist’s ability to identify adverse events early and communicate recommendations directly into the EHR for provider review.

Payer complexity surfaced as a recurring theme. Rim described the growing prevalence of site-of-care restrictions, historically concentrated in rheumatology and gastroenterology but increasingly applied to oncology. He noted that this trend threatens the integrity of in-house infusion programs. Northwestern has responded by launching an infusion hub program designed to redirect care to lower-acuity or home infusion settings when hospital-based infusion is restricted by payers. Carino added a patient-facing dimension: co-pay maximizer programs in which payers partner with third-party administrators to shift co-pay assistance costs from insurers to manufacturers.

Regarding extending integrated pharmacy models to community hospital settings, the panelists acknowledged that community oncology pharmacists often serve simultaneously as clinic pharmacists, specialty pharmacists, and infusion pharmacists. Although this consolidation of roles sustains care, it also risks burnout. “It’s important for pharmacy leadership to recognize the value that’s evident to the providers and to the patients, but it’s important to provide more support and FTEs [full-time equivalents] for those positions in the community settings,” Carino said.

The evening’s discussions collectively illustrated how precision oncology’s clinical advances—including targeted therapies, MRD monitoring, and CAR T-cell treatment—can only translate into population-level benefit when supported by equally sophisticated infrastructure. Processes like streamlined molecular testing workflows, equitable screening programs, and pharmacy models that place clinical expertise alongside the patient at every step are necessary to support. The speakers highlighted that progress in each of these domains will require sustained collaboration across institutions, specialties, payers, and the communities they serve.

References

1. Desai A, Schwed K, Kalesinskas L, et al. Clinical outcomes of perioperative immunotherapy in resectable non–small cell lung cancer. JAMA Netw Open. 2025;8(6):e2517953. doi:10.1001/jamanetworkopen.2025.17953
2. State of lung cancer 2023: lung cancer key findings. American Lung Association. Updated February 5, 2026. Accessed April 2, 2026. https://www.lung.org/research/state-of-lung-cancer/key-findings
3. AJHCS Team. Health equity in action: how RUSH is pioneering community-based solutions. AJHCS. January 31, 2025. Accessed April 2, 2026. https://ajhcs.org/podcasts/health-equity-in-action-how-rush-is-pioneering-community-based-solutions