More people are living longer with cancer, reshaping what patients need from the healthcare system. The U.S. cancer death rate has fallen 34% since 1991, thanks to better screening, diagnosis and treatment, according to the American Cancer Society, even as incidence rises among some younger populations.

Those shifts are adding urgency to a longstanding challenge for payers: how to support innovation, patient access and affordability at the same time. The answer depends not only on which treatments are available but also on whether the organizations managing care are structured and incentivized to put patient and plan value first. As cancer care evolves, early planning, strong evidence, connected data and collaboration will be key to supporting appropriate care, improving access and managing costs.

“Oncology is changing quickly, and patients need support navigating what comes next,” said Abby Kim, PharmD, BCOP, senior director of oncology, clinical strategy and specialty solutions. “Following changes in cancer care helps us anticipate patient needs, reduce barriers and advocate for a clearer path to treatment. Pharmacists and care teams stay connected with patients throughout their care, helping them navigate each step and adapting support as their needs evolve.”

Here are three oncology trends payers should watch.

1. New treatments are adding complexity

Oncology treatment has progressed from single therapies to combinations of two, three or even four medications. While these regimens can improve outcomes, they require closer coordination of dosing, side effects, biomarker testing and patient support.
Payers therefore need to evaluate the full treatment plan, including what the clinical evidence shows, the treatment’s expected benefit and the support patients need to begin and remain on therapy. Connecting medical and pharmacy data can help identify gaps sooner and give health plans, providers and pharmacists a shared view of the patient journey. Because Prime’s model does not depend on steering prescriptions to owned pharmacies, care and access decisions are evaluated based on clinical appropriateness, patient needs, client priorities and total cost of care.

Prime’s IntegratedRx^® program demonstrates how aligned incentives can connect care and cost. By coordinating pharmacists, prescribers and care teams around the patient’s treatment plan, the program supports more integrated pharmacy care while preserving provider and patient choice. It has delivered more than $150 million in total client savings and reduced total medical cost of care by 9% for cancer patients, according to Prime’s latest internal data.

2. Advanced therapies are moving into more care settings

Chimeric antigen receptor (CAR) T-cell therapies, and other complex treatments, were once concentrated in inpatient academic centers. As experience grows, some care is moving to outpatient hospitals and qualified community practices, which could expand access and allow more patients to receive care closer to home.

The right site of care should reflect patient needs, clinical capabilities, quality and value. Payers can support access by aligning with oncology partners equipped to deliver complex therapies safely and by evaluating options based on outcomes, patient experience and total cost of care.

Prime is seeing this shift through integrated oversight, site-of-care analysis and real-world evidence. Prime research presented at the 2026 Academy of Managed Care Pharmacy (AMCP) annual meeting found growing CAR T-cell and BiTE therapy use in outpatient settings, helping payers evaluate where these treatments can be delivered safely and appropriately. 

3. Consolidation is changing how oncology care is delivered

Community oncology consolidation refers to the growing trend of independent oncology practices joining larger organizations generally through health system acquisitions, national oncology networks or private equity-backed platforms. As cancer care becomes more complex and resource-intensive, many practices are seeking scale to support capabilities such as precision medicine, biomarker testing, patient navigation, advanced therapies and value-based care. Supporters argue that larger networks can help preserve local access to community oncology while expanding access to clinical trials, specialty services and infrastructure that may be difficult for independent practices to sustain alone. Critics, however, question whether consolidation creates meaningful value or primarily increases provider market leverage and health care costs. Health plans are evaluating whether these arrangements improve outcomes, access and affordability, while working to ensure the value they create reaches patients, employers and plan sponsors rather than remaining with the organizations gaining greater scale and market power.

Prime’s differentiated model helps health plans navigate this changing landscape with more than 20 years of oncology management experience. Its programs support more than 15 million lives, address 97% of cancer types and manage more than 300 oncology and companion drugs. Prime also reports 98% provider satisfaction, reflecting its focus on clinical collaboration and a smoother experience for providers and patients.

How Prime helps connect care and cost

Together, these capabilities help payers respond to advances in oncology with connected data, clinical expertise and strong partnerships. Just as important, Prime’s approach is designed to align decisions around patient value rather than the use of affiliated assets. That gives health plans, providers, pharmacists and care teams a more complete view of the patient journey so they can coordinate earlier and support access to critical medicines without losing sight of outcomes, affordability or individual needs.

Learn more about Prime’s oncology solutions