Challenges of Step Edits in Oncology

EP: 1.Impact of Recent Policies on US Health Care System and Oncology Practice

EP: 2.Bridging Policy Change With Patient Access and Care Delivery in Oncology

EP: 3.Role of Pharmacy Benefit Managers in Oncology

EP: 4.Impact of Utilization Management Policies in Oncology

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EP: 5.Challenges of Step Edits in Oncology

EP: 6.Understanding Gaps in Aligning Coverage Policy With Innovation in Oncology

EP: 7.Disconnect Between NCCN Guidelines and Coverage Decisions With BTK Inhibitors in CLL

EP: 8.Impact of Evidence-Coverage Misalignment on Patient Outcomes With BTK Inhibitors in CLL

EP: 9.Using Real-World Evidence of BTK Inhibitors to Inform Coverage Decisions in CLL

EP: 10.Balancing Black Box Warnings With Real-World Oncology Practice

EP: 11.Impact of Utilization Management on Physician Autonomy and Shared Decision-Making in Oncology

EP: 12.Shaping Oncology Policy Through Access and Safety Considerations

EP: 13.Impact of Inflation Reduction Act and the Drug Price Negotiation Program in Oncology

EP: 14.Implications of IRA Drug Pricing Negotiations on BTK Inhibitors in CLL

EP: 15.The Future of Oncology Research in a Shifting Policy Landscape

Panelists discuss how step edits—requirements for patients to try less costly therapies before accessing preferred treatments—create barriers in oncology. They note that these policies can undermine individualized treatment plans, forcing clinicians to prescribe suboptimal regimens despite strong clinical rationale for alternatives.

Delays from step therapy can worsen disease progression and increase patient distress. Panelists emphasize that in rapidly evolving fields like oncology, step edits often fail to keep pace with new evidence and approved therapies. They advocate for payer collaboration to integrate current data into policy design, minimizing unnecessary hurdles.

Ultimately, they stress that true value-based care should prioritize the right therapy for the right patient at the right time, not simply the lowest upfront cost.