Ted Okon: I’m Ted Okon, the executive director of the Community Oncology Alliance (COA).
OBR: What does the theme of this year’s conference mean to you?
Okon: The theme of the meeting this year is “Stronger Together.” What that means is there are a lot of divergent forces within oncology and cancer care. Basically, the idea is that independent community oncology is stronger working together. What that means on a practical level is sharing ideas, sharing thoughts, and getting together for advocacy. Especially in this day and age, where we woke up in 2024, and a little while into the year, we found a momentous occasion with this Change Healthcare [cyberattack], which was a real crisis. We are stronger together. We’re stronger together, working and pushing together forward.
That’s why we spent a lot of time talking to the White House, talking to the Centers for Medicare & Medicaid Services (CMS), and actually talking to United Healthcare. The CMO reached out to me. So [we’re] stronger together. The interesting thing is, in order to be stronger together, everybody has to be a champion. And [former NFL quarterback] Joe Theismann, who gave the keynote address at the conference, really stressed the idea that you need to be a champion every day.
OBR: How does having a united front help with community oncology advocacy?
Okon: If the Change Healthcare event doesn’t ring home that you have to be an advocate, that you have to have connections with your state and local representatives – in the case of COA, [we have connections] with the White House, with CMS, and even with United Healthcare – I don’t know what will. Because I tell physicians all the time, you can’t just be an oncologist. You can’t just be a doctor. You have to be an advocate for your patients because we live in a world that is awash in all kinds of changes. And no pun intended, but nobody ever thought that the major pipeline – people didn’t even know what Change Healthcare was – was going to go down and sort of sever relations between, or literally a conduit between, practices and payers. If this hasn’t taught us anything, I don’t know what will.
OBR: Other than the Change Healthcare hack fallout, what other top issues is COA working on?
Okon: We went into the year worried about and looking at pharmacy benefit managers (PBMs), hospital consolidation, 340B site neutrality, and site neutral payments. Because it’s just a fact that, regardless of the pharmaceutical companies, the PBMs are fueling drug costs for Americans, as well as the hospitals too. Hospital care is just more expensive, and there’s a lot of consolidation in both industries. The top PBMs are owned by the top insurers.
They own mail-order pharmacies. Hospitals are getting bigger and bigger and bigger [by] consolidating. But little did we know that when we woke up in 2024, we would see Express Scripts, one of the top PBMs, put out lowball reimbursement and then, a month later, that all of a sudden Change Healthcare would have a dramatic event.
I mean, this is a real crisis in terms of severing the relations between the practice and the payer. Literally, they were treating cancer patients, they were incurring expenses for staff and overhead for drugs, but no payments were coming in. That caused a real wrinkle. But we’re working through the Change Healthcare situation. We’re working through lowball reimbursement by the top PBMs. And we’re very actively involved in all of those issues, including the fact that the government has blocked practices from literally delivering a drug via the mail, a courier, UPS or FedEx, or even having a caregiver – a representative of the patient – come in and pick up the drug. So that’s a big issue for us as well too.
So we are very active on a number of different fronts. There are drug shortages out there that we’re working on, and physician payments from Medicare approximate babysitting rates. We keep on getting cut and cut and cut. There are just so many issues that we’re working on and working through at a rapid pace.
OBR: What are your predictions for this year as far as legislative actions affecting community oncology?
Okon: Well, first of all, Congress is broken. Also, because it is a major election year, both sides don’t want to give the other side a victory. We barely, barely got the government funded. And there are a lot of healthcare initiatives, especially a lot of PBM bills – or as I like to call them, anti-PBM bills – that haven’t gone anywhere. I think what’s probably going to happen is that you may see a couple of healthcare bills come out of the House. I don’t know where they’ll go in the Senate.
But for the most part, I think what we’re looking at is a lame-duck session. That’s after the elections and depending on whether the Republicans keep the House or lose the House, whether the Democrats keep the Senate or lose the Senate, and what happens to the White House. Typically, what happens in a lame-duck [session] is that there’s a big Christmas tree with a lot of ornaments on it. Translation: It’s a bill with a lot of different things that outgoing members of Congress who have lost their seat want to get done before they’re out of Congress. I think you’re going to see a lot of activity in the lame-duck session, but it’s also going to depend on the dynamics of what happens to the House, the Senate, and the White House.
OBR: What developments have taken place regarding the Stark Law issue?
Okon: During the public health emergency (PHE) [for the pandemic], CMS came out and basically said, “Hey, don’t worry, there’s a waiver during the PHE, and it’s not a violation of Stark Law – which is an anti-kickback law – if you basically deliver a drug or have somebody come in and pick it up.” We said, “When was that ever the case?”
We have spent an inordinate amount of effort [on this]. There are two bills in Congress right now, one in the House and one in the Senate. The one in the House has over 50 members, and we are pushing that very actively. It was actually marked up out of the Health Subcommittee of the Energy and Commerce Committee a couple of weeks ago. We want to see it marked up, passed out of the full committee, and passed out of the House and the Senate.
At the same time, we are actually suing the government. Two weeks ago, oral arguments were held on the government’s motion to dismiss. It was really interesting because afterwards there were about six lawyers for the government there. As we were walking out, I couldn’t help saying, “You know what? You guys are defending literally against the woman whose husband died during the night.” She’s a cancer patient. She had to get her drugs the next day. True story. And she couldn’t have anybody go pick the drugs up for her or have the drugs delivered. She had to get her daughter to drive her to the practice, and she had to physically go in to pick up the drugs. I looked at them and I said, “That’s inhumane, and that’s what you are fighting against.”
It’s a lot of effort. It’s a top issue of ours. We’re going to get this fixed one way or another, whether it’s legislatively or legally. But it is really bad, and I can’t understand how a president – and I don’t mean this politically – but how a president who has put so much effort into the Cancer Moonshot and who had a son who died of cancer can literally let his administration get in the way of cancer patients getting their oral cancer drugs. It just does not make any sense at all.
This transcript has been lightly edited for clarity.
