Understanding Gaps in Aligning Coverage Policy With Innovation 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

EP: 5.Challenges of Step Edits in Oncology

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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 coverage policies frequently lag behind scientific advances in oncology. They highlight a growing divide between clinical innovation—such as precision therapies and real-world data insights—and payer frameworks that remain rooted in outdated evidence hierarchies.

This misalignment often leaves patients without access to optimal treatments and providers constrained by restrictive formularies. Panelists recommend adaptive coverage models that evolve with emerging trial data and postmarket findings, ensuring policies remain relevant to contemporary clinical practice.

They conclude that improving dialogue between payers, researchers, and clinicians is essential for harmonizing innovation with reimbursement strategies that support both affordability and patient outcomes.