Managed Care Cast News Roundup: July 8, 2025

RFK Jr Sued by Medical Societies Over Unlawful COVID-19 Vaccine Rollbacks

Six major medical organizations and a pregnant physician have filed a lawsuit against HHS Secretary Robert F. Kennedy Jr, alleging that his removal of COVID-19 vaccine recommendations for pregnant individuals and children was unlawful, unscientific, and dangerous. Filed on July 7, 2025, in the U.S. District Court for Massachusetts, the suit argues Kennedy bypassed standard federal procedures and undermined expert guidance by dissolving the CDC’s vaccine advisory committee and replacing members with vaccine skeptics. The plaintiffs, including the American Academy of Pediatrics, American College of Physicians, and Society for Maternal-Fetal Medicine, warn that Kennedy’s actions are eroding public trust, spreading misinformation, and jeopardizing maternal and child health. They are seeking injunctions to halt the changes and restore science-based policy, emphasizing that Kennedy’s unilateral moves threaten decades of established vaccine infrastructure and the physician-patient relationship.

How AI Can Address the Troubled Business Model in Oncology

Over the past 15 years, oncology has experienced a technological revolution, from the adoption of electronic health records under the Affordable Care Act to today's emerging use of artificial intelligence (AI) to address mounting clinical and operational challenges. While groundbreaking therapies like CAR T-cell treatment and supportive services like navigation and palliative care have advanced care, community oncology practices now face a crisis: growing staff shortages, declining Medicare reimbursement, and increasing burnout. At a June 2025 meeting hosted by Tennessee Oncology, leaders highlighted how AI is no longer a future concept but a practical solution, helping streamline operations, support clinical decisions, and ease documentation burdens. Tools like Flatiron Assist, OncoSmart, and DeepScribe are enabling practices to deliver high-quality care more efficiently despite fewer resources. As costs rise and workforce gaps widen, AI may be the key to sustaining and expanding the gains of the past decade.

Insurance Gaps Threaten Cancer Treatment Success

A new cross-sectional study reveals that while immune checkpoint inhibitors (ICIs) have improved survival for patients with stage IV melanoma, non–small cell lung cancer (NSCLC), and renal cell carcinoma (RCC), the benefits are not evenly distributed across insurance types. Patients with private insurance experienced greater survival gains compared with those on Medicaid or uninsured, highlighting widening disparities despite widespread ICI adoption. The study analyzed data from over 183,000 patients between 2002 and 2019 and found that while survival rates improved across all groups after ICI approval, gaps persisted—and in some cases widened—especially for the uninsured. The findings suggest that expanding Medicaid coverage and offering financial assistance and patient navigation programs may help close these gaps. However, limitations such as a lack of data on cancer-specific mortality and insurance changes during treatment highlight the need for further research to understand and address the inequities in access and outcomes.

Without IRA Fix, COA Warns Community Oncology Practices Will Shut Down

The Community Oncology Alliance (COA) has issued a warning that provisions of the Inflation Reduction Act (IRA) could severely undermine community oncology practices unless Congress or CMS intervenes. In a detailed letter to CMS, COA criticized the upcoming shift in Medicare Part B drug reimbursement—from the current average sales price (ASP) plus 6% model to a lower "Maximum Fair Price" (MFP) plus 6%—as financially devastating, particularly for practices administering high-cost cancer therapies. COA also raised concerns about the operational burden of managing separate drug inventories and the increased costs tied to manufacturer rebate options. Combined with recent cuts to physician payments, fallout from the Change Healthcare cyberattack, and longstanding challenges like prior authorization and competition from 340B hospitals, COA argues the system is nearing a breaking point. The group is advocating for a legislative “carve out” to protect providers or, failing that, for CMS to use its authority to mitigate harm. COA leaders stressed the urgency of action ahead of 2028, when the IRA’s Part B price negotiation rules take effect, warning that smaller oncology practices may not survive without meaningful reform.

Practical Considerations for AI in Community Oncology

At a recent “Tech Innovations in Community Oncology” event, experts debated whether artificial intelligence (AI) can meaningfully improve daily oncology practice, amid skepticism rooted in past disappointments with electronic health records. Panelists highlighted how modern AI can now proactively analyze vast data sets, identify care gaps, and personalize treatment decisions, potentially easing physician workloads and improving patient outcomes. However, challenges remain, including data standardization, equitable access, funding, and ensuring clinical accuracy. Speakers emphasized that AI must remain a supportive tool, not a decision-maker, with validation and oversight shared across the health care ecosystem. While AI holds promise for transforming oncology care and reducing inefficiencies, success will depend on responsible adoption, robust infrastructure, and collaboration among providers, payers, and technology developers.

Narration was generated using AI.