Recent U.S. approvals of subcutaneous (SQ) atezolizumab, nivolumab, and pembrolizumab reflect a shift in immune checkpoint inhibitor (ICI) delivery and point toward continued expansion of ICI SQ reformulations.¹⁻⁴ Convenience-driven IV-to-SQ reformulation is not new in oncology; earlier SQ biologics such as the fixed-dose pertuzumab/trastuzumab combination (Phesgo) demonstrated shorter chair time, lower resource use and strong patient and staff preference for SQ administration.⁵˒⁶ Yet the shift to SQ ICIs introduces a range of implications for patients, providers, and payers that differ across products and extend beyond convenience alone.  

Patient Perspective  

For patients, SQ ICI reformulations reduce reliance on venous access and shorten treatment visits by replacing infusions with brief injections. However, convenience gains may diminish in scenarios where SQ offers less benefit, including when other IV drugs are required or monitoring is prolonged. SQ ICI safety profiles are generally consistent with IV formulations; the principal route-specific distinction is a higher frequency of mild, self-limited injection-site reactions.⁶ Despite shorter encounters, post-visit education, accessible triage, and clear escalation pathways remain essential given the potential for immune-related adverse events after discharge.⁷

Provider Perspective 

For oncology practices, SQ ICIs convert infusion center visits into shorter injection encounters that can often be performed in the provider office. This shift can relieve infusion chair capacity and simplify scheduling while maintaining clinical oversight. Time-and-motion data with SQ pembrolizumab show roughly 45%–50% reductions in chair time, treatment room time and active health care provider (HCP) task time versus IV, reinforcing gains in throughput and staffing flexibility.⁸˒⁹ These efficiencies reduce operational costs and contribute to downstream savings from lower resource use, streamlined handling and less drug waste.⁶ Even so, adoption may be slower in settings where chair-time revenue is significant, as practices must weigh reduced infusion-related billing against operational efficiency gains.  

These shifts also bring practical implementation needs. Integrating SQ ICIs into practice may require updating order sets, modifying clinic workflows, and training staff in high-volume SQ administration techniques.¹⁰ Coding and billing readiness can also affect rollout timing as temporary HCPCS codes transition to permanent ones.¹¹  

Payer Perspective 

From the payer perspective, the shift to SQ ICIs affects site-of-care, biosimilar dynamics, and utilization management. 

Site of Care 

The IV to SQ shift can move the site-of-care away from hospital outpatient departments to lower-cost settings, especially for monotherapy regimens. All three SQ ICI labels require HCP administration, allowing office-based administration and HCP-administered home delivery, but not self-injection.¹⁻³ When clinically appropriate, aligning reimbursement with these settings can reduce facility fees while preserving safety. Real-world oncology experience shows that HCP-administered home delivery is feasible with structured workflows and monitoring, and early studies in non-small cell lung cancer are generating ICI-specific evidence for nurse-administered at-home dosing.¹²˒¹³ To scale safely, payers and providers must ensure reliable cold chain and delivery logistics, standardized observation and escalation pathways, remote oversight and clear billing pathways for home-based services.¹⁴ 

Biosimilars  

With no U.S. ICI biosimilars approved as of early 2026 but several candidates in development, broad early adoption of branded SQ agents may dampen later price competition if switching back to an IV product proves limited.¹⁵˒¹⁶ For pembrolizumab in particular, SQ reformulation also aligns with broader patent-extension strategies given the approaching loss of exclusivity for the IV formulation.¹⁵˒¹⁶ Payers may consider contracting approaches that anticipate biosimilar entry and address interchangeability and switch logistics.⁹˒¹⁶ 

Utilization Management 

Utilization management (UM) for SQ ICIs may reflect two labeling distinctions: how SQ and IV indications differ, and whether IV dosing must precede SQ use. Because indication overlap is not uniform across agents (e.g., SQ nivolumab excludes ipilimumab-containing regimens), UM criteria may vary by product; key differences are summarized in Table 1. While SQ atezolizumab and SQ pembrolizumab do not require prior IV exposure, SQ nivolumab includes certain indications where SQ is used only after patients have received IV nivolumab + ipilimumab.¹⁻³ In practice, some regimens may still begin with IV based on patient or provider preference, and when a switch to SQ is anticipated, payers can reduce delays by issuing both IV and SQ PAs at treatment onset.⁸  

Key Takeaways  

• Patients: The shift to ICI SQ delivery translates to shorter visits and simplified logistics that often improve the treatment experience.  
• Providers: These formulations can relieve infusion-chair pressure and improve clinic throughput, but practices must balance these gains against revenue considerations, workflow and coding changes, and the need to maintain ICI clinical oversight.  
• Payers: SQ delivery may shift site-of-care toward office-based or HCP-supervised home settings, while biosimilar timing and product-specific UM rules shape contracting. As evidence on home administration and biosimilar entry matures, aligning PA processes, site-of-care reimbursement, and post-visit triage will be key to realizing the full value of SQ ICIs without compromising safety.