Why Cancer Drug Access Takes Time: Scott A. Soefje, PharmD, MBA

Logistics, contracts, and cost determine how quickly newly approved cancer drugs reach patients, according to Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy for cancer care and associate professor of pharmacy at the Mayo Clinic in Rochester, Minnesota. In an interview at the Patient-Centered Oncology Care® (PCOC^®) 2026 conference hosted by The American Journal of Managed Care^® in Nashville, Tennessee, September 24-25, 2026, Soefje discussed topics from the panel discussion, “From FDA to Formulary: A Look at Therapy Selection in Comprehensive Cancer Centers.”

What Delays Access to New Drugs

Soefje said the answer depends on the drug and the barrier involved. When a community practice lacks capabilities such as liquid nitrogen storage or apheresis for chimeric antigen receptor (CAR) T-cell therapy, teams often focus on the main institution. Delays tied to economics, such as a missing contract for a given site, take longer to resolve.

"We do everything in our power to try to get the patients the drug as quickly as we can," Soefje said. "That being said, there are still a lot of logistical hurdles. There are operational barriers. There are economic considerations that will influence whether we choose to carry a drug or not carry a drug."

Soefje noted that institutions increasingly see what he calls "Me Too" drugs, which offer similar efficacy and safety within the same class. In these cases, pharmacy leaders ask disease groups which single option they would choose, or whether they would accept one in exchange for a better contract or economic advantage for patients.

Why High-Cost Drug Committees Emerged

High-cost drug committees developed alongside CAR T-cell and gene therapies, Soefje explained. Payers generally will not reimburse the traditional infusion center markup on these products, which led to single-case agreements. Committees now weigh whether patient volume justifies stocking a drug or whether patients should be referred to a higher-volume site in the region or network.

"A $2 million drug mishandled multiple times could be a significant impact to an organization," he said. Review thresholds vary by institution. "It's just that added layer of protection for the institution to say, yes, this is the right drug."