Role of Pharmacy Benefit Managers 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

Now Viewing

EP: 3.Role of Pharmacy Benefit Managers in Oncology

EP: 4.Impact of Utilization Management Policies in Oncology

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 pharmacy benefit managers (PBMs) play a growing role in determining oncology access and affordability. They explain that PBMs increasingly influence formulary design, rebate negotiations, and drug-tier placement, impacting both providers and patients. While PBMs can help control costs, panelists caution that opaque rebate structures sometimes distort clinical priorities, favoring cost-driven rather than evidence-driven decisions.

They highlight how PBMs’ influence extends to treatment sequencing, prior authorization, and preferred drug lists. This consolidation of control can streamline some processes but also limit flexibility for oncologists to tailor regimens based on patient needs. Transparency and stakeholder collaboration are recurring themes, as participants call for clearer justification of formulary exclusions and step edits.

Ultimately, the discussion underscores the need for greater alignment between PBM strategies, clinical data, and patient outcomes to ensure that financial mechanisms support—rather than impede—quality oncology care.