Rising oncology spending is forcing payers and providers to confront questions of value, access, and sustainability. Scott Soefje, PharmD, MBA, BCOP, director of pharmacy cancer care at Mayo Clinic, identifies accelerated drug approvals, rising prices, and administrative burdens such as prior authorization as the key cost drivers reshaping cancer care.
Soefje says the pace of accelerated approvals often leaves clinicians and payers without final outcomes data while prices climb. That combination, he warns, undermines the ability to assess cost-effectiveness and has encouraged a “what the market will bear” pricing mentality. He calls for renewed emphasis on comparative effectiveness and cost-effectiveness studies so stakeholders can determine which treatments deliver the best outcomes for the price.
Prior authorization remains a major administrative hurdle. Soefje advocates direct collaboration between providers and payers to streamline access—using established guidelines such as NCCN to waive redundant prior authorizations when treatments conform to accepted protocols. He notes Mayo Clinic has negotiated arrangements with some payers that reduce prior authorization requirements, and argues that widespread overuse of these processes imposes large personnel costs without proportionate benefit.
The shift to oral and outpatient therapies has created new adherence and affordability challenges. Intravenous treatments offered in clinic provided built-in adherence checks; oral prescriptions do not. Soefje points to data showing some oral therapies are never filled or are rationed because of cost. He highlights the expanding role of pharmacists, clinic-based monitoring programs, specialty pharmacies, and emerging technologies—including ingestible sensors—to improve adherence, manage side effects, and reduce financial toxicity.
Immunotherapies and cellular therapies pose additional value questions. Soefje questions the proliferation of PD-1 inhibitors without head-to-head comparisons and suggests class-based pricing or bidding could be a way to control costs when drugs are therapeutically equivalent. He also raises concerns about sequencing and cumulative lifetime costs for high-priced modalities such as CAR T and bispecific antibodies, urging rigorous cost-effectiveness analyses and clearer guidance on when to stop therapy.
Across these areas, Soefje emphasizes that maximizing value requires focusing on outcomes as well as costs. He warns that without better comparative data, smarter payment models, wider pharmacist integration, and targeted use of technology, the system risks unsustainable spending that could limit access and force harder policy choices in the future.
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