US commercial payers are increasingly applying utilization management (UM) for oncology therapies, with important implications for costs, clinical practice, and patient access. We used the SPEC database to examine oncology drug coverage policies from 2017 to 2024. Across 5,400 policies for 363 drug-indication pairs, key findings include:
- Excluding prescriber requirements, the share of oncology policies with UM increased from 14.5% in 2017 to 22.9% in 2024.
- UM growth was driven largely by step therapy, which increased from 4.3% to 16.5%; 75% of step therapy policies required biosimilars or generics before branded products.
- UM was more common for biologics, cell and gene therapies, and products with biosimilar or generic competition, with substantial variation across health plans.
- Overall, 35% of oncology policies included UM, compared with 73% for non-oncology policies.
These findings suggest that UM decisions are increasingly driven by the availability of treatment alternatives, rather than therapeutic area alone. Although these trend may support cost-containment, they may also increase administrative burden, influence treatment sequencing, and delay access to care.
Read more at https://ascopubs.org/doi/pdf/10.1200/OP-25-01096