Leslie Busby, M.D., senior vice president and chief medical officer of The US Oncology Network, outlined the pressures facing community oncology and the network’s strategy to help independent practices survive and compete.
A longtime leader within The US Oncology Network Pharmacy & Therapeutics Committee, Busby joined Rocky Mountain Cancer Centers in Boulder, Colorado, in 2002 and became involved with the network’s P&T Committee around 2005. She chaired the committee for six years and assumed the chief medical officer role in July 2025. Despite expanded administrative duties, she continues to see patients one day a week. The US Oncology Network, a subsidiary of McKesson Corporation, encompasses about 2,700 providers across 31 states.
Busby described consolidation and capital constraints as key forces reshaping oncology. Small independent practices face rising costs and payment disruptions that strain cash flow. Private equity and hospital systems offer capital and scale but often require practices to cede control. The US Oncology Network’s hybrid model seeks to preserve physician independence while sharing financial risk and providing management support.
Value-based care in the network centers on a long-running pathways program, now called Value Pathways and powered by the National Comprehensive Cancer Network (NCCN). Developed more than 15 years ago, the program emphasizes “science first, toxicity second, cost third,” Busby said. The approach aims to standardize care, reduce denials and improve consistency. Most network physicians exceed 75 percent adherence to internal pathways and often surpass 90 percent adherence to NCCN guidelines, she noted.
Despite alignment with guidelines, prior authorization remains a persistent administrative burden. Busby said the bulk of requested therapies are ultimately approved, yet manual authorization processes waste clinician time and slow care. She advocates for better system interoperability so payers can automatically recognize guideline-consistent regimens.
On innovations, Busby called CAR-T “remarkable” for its curative potential in some patients but warned it requires extensive infrastructure and carries extremely high costs. Gene therapies for conditions such as sickle cell disease show promise but come with multimillion-dollar price tags. Bispecific antibodies may offer a more manageable cost and toxicity profile, with spending spread over time as clinical experience grows.
Precision medicine and next-generation sequencing (NGS) are expanding rapidly. NGS is now standard in lung cancer, with uptake exceeding 90 percent, and is increasingly used in breast, colon and other cancers. Busby highlighted challenges in keeping clinicians up to date and obtaining timely results. She pointed to emerging applications of artificial intelligence that may predict mutations from pathology slides and the growing ability of genomic and gene-expression data to forecast treatment response.
Busby expressed concern about recent drug-pricing changes and their unintended effects on independent providers. While capping patient out-of-pocket costs is a positive goal, new laws and regulations, including features of the Inflation Reduction Act, have shifted market incentives. She said some manufacturers are moving toward biologics and antibody-drug conjugates after IRA provisions limited exclusivity for oral small-molecule drugs. Practices positioned in the middle of reimbursement flows face cash-flow risks, and uncertainty around average sales price–based reimbursement remains unresolved. These dynamics, she warned, could reduce innovation and constrain patient choice.
Looking ahead, Busby identified the core challenge as balancing innovation with affordability. She called for robust clinical data to justify new therapies, streamlined payer processes to cut administrative burden, and policy reforms that do not disadvantage independent practices. If incentives and infrastructure can be better aligned, she said, precision medicine and AI could make oncology care more personalized, efficient and effective.
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