Florida Cancer Specialists Warns of Payer Barriers Threatening Timely Cancer Care
Event summary
- Florida Cancer Specialists & Research Institute (FCS) and Avalere Health released a national survey highlighting administrative hurdles disrupting timely cancer care.
- The survey of 75 oncology stakeholders in May 2025 found frequent misalignment between payer criteria and physician-preferred treatment plans, particularly in Medicare Advantage.
- FCS recommends eliminating fail-first step therapy in oncology and ensuring oncology specialists oversee prior authorization and appeals.
- Total cancer-related costs are projected to reach $246 billion by 2030, with cancer drugs accounting for 50% to 60% of total oncology care spending.
The big picture
The survey results underscore a growing tension between cost-containment strategies by payers and the need for timely, evidence-based cancer care. As cancer-related costs continue to rise, the shift toward tighter utilization management threatens to disrupt physician-led decision-making and delay critical treatments. FCS's advocacy highlights the broader industry challenge of balancing financial sustainability with patient-centered care.
What we're watching
- Regulatory Response
- Whether regulators will act on FCS's policy recommendations to streamline utilization management and reduce treatment delays.
- Payer Strategies
- How payers will balance cost-containment efforts with the need for timely, physician-led cancer care.
- Industry Advocacy
- The pace at which other oncology practices will join FCS in advocating for policy changes to protect patient access and physician decision-making.
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