Strong Advocacy Helps Address Barriers in Modern Oncology Care: Sucharu "Chris" Prakash, MD

The biggest challenge in oncology is the consolidation and vertical integration of hospitals, insurers, and pharmacy benefit managers (PBMs), which shifts care to large systems, raising costs and limiting patient choices, Sucharu "Chris" Prakash, MD, of Texas Oncology, tells The American Journal of Managed Care^® at the Patient-Centered Oncology Care (PCOC) conference in Nashville, Tennessee.

Amid these challenges, he emphasizes the importance of advocacy, highlighting a recent success in Texas that now allows chimeric antigen receptor (CAR) T-cell therapy outside major metro centers, made possible through the efforts of advocates.

Prakash expanded on these topics earlier today at PCOC during the panel "In a Wave of Change: Advocacy is Everyone's Job," alongside fellow experts Ben Jones; James Lee, MS; and David Eagle, MD.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What oncology reimbursement or access challenges stand out as the most urgent, and how do these issues affect day-to-day practice?

The biggest and most critical issue right now affecting oncology practices is the consolidation that's happening. The hospitals, they are becoming these huge, mega entities. There's vertical integration going on between the hospital systems, insurers, PBMs, all the way down to pharmacies and even physician employment.

Once you have these huge entities, they become very powerful. The shift of care towards the hospital setting from community oncology is a problem for patients. It's more expensive, takes more time to get the care that you want, and the patients don't have a choice, even in physicians, the choice of care they want to receive, and the pharmacies they use. That is the biggest issue.

Of course, there's other issues, including PBMs that are powerful. They dictate how prescriptions are going to be delivered, to whom, when, how long it's going to take, and how much it's going to cost. Those are the main issues that I see right now.

How can new laws and state-level reforms improve access to advanced therapies, such as CAR T-cell therapy, and what role does advocacy play in driving these changes?

Just recently, Texas passed a law to allow CAR T-cell therapies to be available outside of the big metro centers. So far, CAR T-cell therapy could only be delivered in Dallas, Houston, and Austin, at very, very select centers, because they needed a FACT [Foundation for the Accreditation of Cellular Therapy] certification. That's a special certificate accreditation that was required.

Now, because of advocacy efforts from community oncologists all the way to lobbies and policymakers, that requirement has been done away with. That's going to make CAR T-cell therapy available to a lot more people, no matter where they live. For example, if the patient lives in rural northeast Texas or south Texas, they can get CAR T-cell therapy close to home.