The National Comprehensive Cancer Network (NCCN) is seeing meaningful progress in addressing key challenges in cancer care access, while acknowledging persistent hurdles in drug availability and equity concerns. Alyssa Schatz, MSW, vice president of Policy and Advocacy at NCCN, shared these insights during a recent Patient-Centered Oncology Care meeting.
Prior Authorization Reforms Show Promise
Significant strides have been made in streamlining prior authorization processes. CMS has implemented new requirements mandating decisions within 72 hours for urgent care and 7 days for routine care, though these rules don't extend to medications. Additionally, several states have adopted "gold carding" programs, which exempt guideline-adherent physicians from prior authorization requirements.
"Guideline adherence is established in [the] literature as also reducing costs," Schatz explained. "When we have guideline adherence, we are doing what's right for patients, and we're also doing what's economically right."
Currently, approximately 85% of covered lives in the United States are under payers who utilize NCCN guidelines for coverage determinations. UnitedHealthcare's recent implementation of a national gold card program, effective October 2024, marks another significant step forward.
Advancing Health Equity Initiatives
NCCN has intensified its focus on health equity, implementing several key initiatives:
- Transition to organ-based rather than gender-based language in guidelines
- Development of the Health Equity Report Card with 19 measures across 4 domains
- Formation of the Alliance for Equity in Cancer Care to improve clinical trial representation
- Collaboration with CMS on new patient navigation codes for high-risk conditions
"We know that we don't live in a world where everyone gets the same access to optimal cancer care today, and as a guideline organization, that means that our mission can't be achieved," Schatz emphasized.
Drug Shortage Concerns Persist
Despite improvements in the availability of carboplatin and cisplatin, drug shortages remain a significant challenge. A June 2024 survey revealed that 89% of cancer centers are experiencing shortages of at least one type of systemic therapy.
"If we don't take urgent action, we're likely to continue to see recurrent drug shortages. It's going to happen again," Schatz warned, emphasizing the need for addressing root causes through congressional action.
Looking Forward
The oncology community faces both opportunities and challenges ahead. While progress in prior authorization reform and health equity initiatives provides optimism, ongoing vigilance is needed to maintain momentum, particularly with potential administrative changes on the horizon.
Schatz stressed the importance of collaborative advocacy: "I think we only get to good public policy when we have every different facet and perspective understood and informing the policy. Anytime we leave somebody out, there are going to be unintended consequences."
