^{Abby Kim, PharmD, BCOP, is a senior director, clinical strategy and oncology specialty solutions, and author of Oncology Insights at Prime Therapeutics.} 

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Small cell lung cancer (SCLC) remains one of the most aggressive and challenging conditions facing oncology, with rapid progression and a poor long-term prognosis. As the treatment landscape evolves — driven by new immunotherapies, supportive care innovations and new drug approvals — payers play an increasingly pivotal role in shaping access, coverage and the overall patient experience. 

This evolving role of payers extends beyond reimbursement, encompassing support for clinical trial participation, care coordination and quality-of-life initiatives. By fostering collaboration with providers, patients and industry stakeholders, payers are helping shape a more patient-centered and equitable future for SCLC care. 

I recently joined Kevin Chen, PharmD, MS, BCOP, CPP, clinical pharmacist practitioner, department of pharmacy, University of North Carolina Hospitals; Amanda Cass, PharmD, BCPS, BCOP, clinical pharmacist specialist, thoracic oncology, Vanderbilt University Medical Center; and Darren Luon, PharmD, BCOP, clinical pharmacy specialist, thoracic oncology, Yale New Haven Hospital, for an American Journal of Managed Care (AJMC) forum, “Bridging evidence and access in advanced small cell lung cancer.”  

This forum, accredited by Accreditation Council for Pharmacy Education (ACPE) through Pharmacy Times Continuing Education™, explored evolving treatment approaches and clinical guidance for extensive-stage small cell lung cancer (ES-SCLC), reviewed emerging therapies and offered managed care strategies to ensure timely, equitable access to evidence-based treatments. 

Here are some of the key takeaways from the forum.  

Aligning access with clinical evidence and guidelines  

In recent years, the treatment landscape for ES-SCLC has evolved with the introduction of immunotherapy. Both atezolizumab (Tecentriq) and durvalumab (Imfinzi) are approved by the U.S. Food and Drug Administration (FDA) as first-line treatment options for ES-SCLC, each carrying a Category 1 recommendation from the National Comprehensive Cancer Network (NCCN) and showing similar safety and survival outcomes. For patients, the main difference is convenience. Durvalumab’s once-every-four-weeks maintenance dosing may reduce infusion visits compared to atezolizumab’s every-three-weeks schedule. Their similar clinical outcomes and strong guideline support mean payers typically provide coverage for both options, allowing use to focus on patient and operational considerations rather than clinical preference.  

Balancing efficacy, safety and cost 

Payers aim to keep up to date with the latest evidence so patients can access approved treatments quickly. While effectiveness of treatment is the top priority, safety and cost also matter — especially when several options work equally well. In those cases, cost-effectiveness and efficient use of resources become more important. 

Managed care oncology pharmacists and physicians play a critical role in evaluating emerging clinical and economic evidence before therapies reach patients. At Pharmacy & Therapeutics (P&T) committee meetings, they review trial data, safety profiles and real-world outcomes to help ensure that formulary decisions reflect both efficacy and best practice standards. This rigorous process helps maintain consistency in care while balancing innovation with responsible resource allocation. 

Supporting clinical trial access  

Managed care organizations play an important role in supporting patient access to clinical trials, especially for difficult-to-treat cancers like SCLC. By covering routine care costs, streamlining administrative processes and collaborating with providers and sponsors, payers can help minimize barriers to trial participation. Innovative programs addressing transportation, lodging and patient navigation further enhance equity and participation. Importantly, payers are also educating patients and providers about the value of clinical trials, reframing them as opportunities for cutting-edge care rather than last-resort options. 

Navigating accelerated approvals and policy updates 

The rise of accelerated approvals in oncology has enabled faster access to promising therapies for patients with high unmet needs. Payers typically align coverage with FDA labeling and NCCN recommendations, but they are highly invested in the timely completion of confirmatory trials to validate long-term efficacy, safety and value. Many organizations conduct ongoing policy reviews, monitor regulatory updates and incorporate real-world data into value assessments to help ensure continued alignment with evolving evidence. 

Recognizing that policy updates can lag behind new approvals, payers have implemented expedited review processes and interim strategies to bridge the gap, helping patients receive evidence-based care when they need it. 

Enhancing care coordination and quality of life 

Beyond coverage decisions, payers are increasingly focused on care coordination and quality-of-life for oncology patients. Many health plans now offer dedicated oncology care management programs or partner with specialized virtual care vendors to provide nurse navigation, symptom monitoring and psychosocial support. These services complement in-person care, facilitate early intervention and connect patients to supportive resources such as nutrition and behavioral health. By leveraging telehealth and digital platforms, these programs aim to reduce emergency room visits, improve adherence and optimize site of care — all with the goal of enhancing patient experience and outcomes. 

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