A national survey of independent community oncology practices has found that utilization management tactics imposed by health insurers and pharmacy benefit managers (PBMs) delay cancer treatment, interfere with physician-directed care, and increase administrative and financial burdens on practices treating patients with cancer.
Released by the Community Oncology Alliance (COA), the survey of oncology professionals from across the United States found near-universal consensus that step therapy, prior authorization, and related requirements have worsened over time and are actively harming patients with cancer.
Among the 110 oncology professionals who responded to the survey:
- 90.8% do not believe that insurance companies or PBM policies align with clinical recommendations.
- 92.1% reported that step therapy has made utilization management for oncology treatment more time-consuming over the last 5 years.
- 96.6% have observed patients with cancer struggle as a direct result of insurer-imposed step therapy.
- 96.6% said insurance company policies interfere with patients accessing the treatment their physician recommends first.
- 89.3% reported having to add staff over the last 5 years solely to manage insurance company and PBM paperwork.
- 86.9% believe that current appeals processes are not adequate or reasonable.
“As an oncologist, I know that delays and forced treatment changes are not merely administrative inconveniences. They alter the course of disease,” said Debra Patt, MD, PhD, MBA, Executive Vice President Policy and Strategy at Texas Oncology, and President of COA. “This survey confirms what physicians in community oncology see every day: insurers are overriding evidence-based treatment decisions and placing patients with cancer at risk. Delays and detours in appropriate evidence-based care harm patients.”
Survey respondents also detailed the real-world consequences behind the data. Oncology professionals described patients with aggressive cancers waiting weeks for treatment approvals that were ultimately granted without any changes. Others reported patients being forced through step therapy regimens that led to disease progression, severe side effects, or emergency hospitalizations before insurers approved the originally prescribed therapy. Several respondents said patients abandoned recommended treatment altogether after repeated denials, citing emotional distress, confusion, and financial strain.
“These findings make clear that utilization management is no longer a paperwork problem,” said Ted Okon, MBA, Executive Director of COA. “Health insurers and PBMs are inserting themselves directly into cancer treatment decisions. Despite consistent evidence of harm, these policies continue to expand, delaying care and second-guessing oncology specialists.”
In addition to patient harm, the survey findings highlight the growing operational and financial strain on community oncology practices. Most respondents reported having to increase full-time employee staffing over the last 5 years solely to manage expanding utilization management and step therapy requirements, signaling that insurer-imposed barriers are worsening and forcing practices to divert employee time and resources away from direct patient care.
“Practices are being forced to hire full-time staff whose primary role is to manage denials, appeals, and step therapy requirements,” said Shiela Plasencia, Director of Practice Support at COA. “Those are unnecessary expenses driven entirely by insurer barriers, not patient need. Every additional full-time equivalent devoted to utilization management is time and money diverted away from direct patient care.”
COA is a national nonprofit organization representing independent community oncology practices that provide the majority of cancer care in the United States. COA has long warned that utilization management is particularly dangerous in oncology, where treatment sequencing is not interchangeable and delays can permanently affect outcomes. In formal position statements about physician autonomy and step therapy, as well as policy analyses, COA has documented how these insurer-driven practices erode physician autonomy, interfere with evidence-based decision-making, and weaken the physician-patient relationship.
The survey results arrive amid increased federal scrutiny of health insurers and PBMs, including health insurers publicly pledging to address prior authorization concerns, as well as recent congressional hearings examining access, affordability, and insurer decision-making.
The survey was fielded to COA board members, networks, and members working in independent community oncology practices nationwide. Responses were collected over a 2-week period from January 13 through January 27, 2026, and included both quantitative data and free-form descriptions of patient and practice impact.
