Step-Edits in Oncology Sign-On Letter 

The undersigned organizations and individuals represent cancer care centers, oncology professionals, patients with cancer, their caregivers, patient advocates, and all stakeholders across the cancer care community. Together, we are committed to ensuring patients receive timely access to safe, effective, and evidence-based cancer treatments. 

We are writing to express our urgent concern regarding the use of step edit policies for cancer medications in Medicare Advantage and commercial plans, which delay or deny access to life-saving therapies and create life-threatening barriers to appropriate cancer care.  

Cancer treatment decisions are complex and individualized. Oncologists develop treatment plans based on clinical evidence, patient-specific characteristics, disease biology, and evolving standards of care. Step edit requirements that force patients to try and fail therapies before accessing the treatment recommended by their care team can disrupt these carefully developed treatment strategies. 

For patients facing cancer, time matters. Delays in initiating the most appropriate therapy may contribute to disease progression, additional toxicity, emotional distress, and avoidable complications. Policies that require patients to “fail first” can undermine patient-centered care and interfere with the clinical judgment of oncology providers. 

Beyond their clinical implications, the emotional burden step-edit policies place on patients, and their caregivers is substantial, yet often not given the importance it deserves. A cancer diagnosis is often accompanied by fear, uncertainty, and urgency.

When patients are required to delay or forgo the therapy recommended by their care team, it can increase anxiety, diminish confidence in the care process, and create a sense of helplessness during an already vulnerable time. Access to appropriate treatment should not add emotional strain to patients who are already navigating a life-threatening illness.  

Step edit requirements also create substantial administrative burdens for oncology practices. Care teams must devote considerable time to navigating prior authorizations, appeals, and documentation requirements. These administrative barriers divert valuable resources away from patient care and place additional strain on already complex oncology care delivery systems. 

At the same time, oncology care continues to evolve rapidly with the development of targeted therapies, biomarker-guided treatments, and personalized medicine approaches. Policies that rely on rigid step therapy protocols may not reflect current clinical evidence or the individualized nature of cancer treatment. 

We respectfully urge policymakers, payers, and healthcare stakeholders to work collaboratively with the oncology community to ensure that coverage policies: 

• Prioritize timely access to clinically appropriate cancer therapies 

• Exempt oncology regimens from step edit policies  

• Minimize policies that contribute to unnecessary emotional distress for patients and care givers 

• Respect the patient relationship and clinical expertise of oncology providers 

• Reflect current evidence-based treatment guidelines 

• Reduce unnecessary administrative barriers that delay care 

The oncology community shares the goal of delivering high-quality, evidence-based care while promoting responsible use of healthcare resources. Achieving this goal requires policies that support—not hinder—patient-centered cancer treatment. 

We welcome the opportunity to work collaboratively with stakeholders to develop solutions that ensure patients receive the right therapy at the right time. 

Thank you for your attention to this important issue. 

Please note that, if signing on behalf of your organization, only your organization name will appear on the letter and you must be authorized on behalf of your organization to commit to signing publicly. 

NCODA brings together a passionate network of oncology experts and care teams from across the country and around the world, advancing the future of oncology pharmacy and supporting a unified, patient-first approach to cancer treatment. Join us in the Mission today.

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Step-Edits in Oncology

Sign-On Letter