White Paper
Access Challenges in the Cancer Patient Journey
Aug 13, 2024
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Oncology is rapidly growing in the U.S., with medicine spending increasing by $10 billion to $91 billion from 2022 to 2023. Advances in cancer treatment have led to multiple effective therapy options and extended survival, increasing therapy utilization. However, market competition and higher volumes have prompted payers to increase control and raise access hurdles. This report explores several key points in oncology access:

1. Barriers to Therapy: Access controls are expanding, making it harder for patients to start and maintain therapy.
2. Formulary Exclusions: Since 2021, the use of formulary exclusions in oncology medicines has been rising, affecting both provider- and self-administered treatments.
3. Affordability: Drug prices and financial support are critical issues impacting therapy acquisition.
4. Dispensing Sites: Payer networks often limit patient choices, requiring prescriptions to be filled at specific pharmacies.
5. Medicare Part D Changes: The Inflation Reduction Act's changes to Medicare Part D, including the elimination of 5% patient coinsurance in the Catastrophic phase, may improve affordability but could also lead to greater payer restrictions and "skinny" formularies.

These factors collectively impact patient access to necessary oncology treatments. Read this paper to dive into the details.
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