Oncology

Rising utilization management for oncology therapies in US commercial plans, 2017–2024

From 2017 to August 2024, the proportion of oncology coverage policies with utilization management (UM) rose to 35.2% versus 73.2% for nononcology drugs. UM use varied widely across plans (range 12.1%–40.0%) and increased excluding prescriber requirements from 14.5% to 22.9%, driven mainly by step therapy. UM was more common for cell and gene therapies, biologics, and products with biosimilar or generic competition. Most oncology policies cited NCCN guidelines, highlighting evolving coverage practices with implications for sequencing and access. 1

VHA patients with NSCLC had larger 3‑year survival gains than non‑VHA (2007–2019)

In a retrospective cohort (VHA n=79,027; NCDB n≈1.38 million), adjusted 3‑year overall survival rose from 24% to 51% in the VHA and from 24% to 41% in non‑VHA settings between 2007 and 2019. The VHA survival advantage persisted across disease stages and when comparing to NCDB patients with Medicare or private insurance. Authors attribute differences to care delivered in an integrated, publicly funded system, but causality cannot be assumed from observational data. 2

Network meta‑analysis: perioperative taxane‑triplet + ICI ranks highest for resectable G/GEJ

Bayesian network meta‑analysis of 30 RCTs (11,547 patients) ranked perioperative taxane‑based triplet chemotherapy plus an ICI highest for OS (SUCRA=0.952) and DFS (SUCRA=0.959). Compared with taxane‑triplet alone, the chemo‑immunotherapy regimen showed DFS benefit (HR 0.72; 95% CrI 0.56–0.93), while OS effect was imprecise (HR 0.79; 95% CrI 0.59–1.05). Toxicity estimates were consistent with known patterns and did not show increased high‑grade adverse events with ICIs, but conclusions rely on indirect comparisons and sparse direct evidence. 3