Oncology providers and advocates at the 2025 Patient-Centered Oncology Care Conference warned that declining Medicare and Medicaid reimbursements threaten patient access and the viability of community practices.
Panelists said reimbursement has shifted in recent decades, with hospital payments rising while community practice rates have largely plateaued. Ben Jones of The US Oncology Network called for reimbursement plans that reflect current inflation and move beyond short-term fixes, noting that Medicare’s higher payments for hospital-based care have driven hospital acquisitions of physician practices.
Speakers highlighted the growing consolidation of health systems. Sucharu “Chris” Prakash of Texas Oncology described both horizontal and vertical integration—health systems, insurers, pharmacy benefit managers and pharmacies owned by the same entities—which he said pushes care away from community and rural settings toward more expensive hospital care.
Medicaid and Medicare cuts were identified as particular threats to rural and socioeconomically disadvantaged populations. Practitioners in states without Medicaid expansion face steep impacts, and practices that rely heavily on Medicaid—Eagle said it accounts for nearly one-third of his practice’s revenue—could struggle to remain open.
Panelists also criticized pharmacy benefit managers (PBMs) for creating barriers to care. Discussion referenced recent legal and legislative efforts to regulate PBMs, including state measures to limit PBM ownership of pharmacies; some actions remain stalled in court. James Lee of the Community Oncology Alliance urged continued state-level reform efforts while warning PBMs often resist regulation by citing federal preemption.
Regulatory changes in some states were noted as potential models. Texas recently eased accreditation requirements for centers offering CAR T-cell therapy, a move panelists said could expand access in rural areas. Conversely, increases in prior authorization requirements—including growing use in Medicare Advantage—were described as causing harmful delays and denials for cancer patients.
The panel emphasized that clinicians must engage in advocacy to protect access to care. Practical steps include building relationships with policymakers, inviting them into practices, participating in community meetings and using advocacy resources to explain the unreimbursed costs of providing oncology services. Panelists urged consistent, early engagement to influence policy decisions that affect patients and practices.
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