Inside the Legislative Battle Over Oncology Patients’ Access to Critical Medications

In this interview, David Eagle, MD, discusses the ongoing legislative and advocacy efforts to overturn the CMS policy restricting community oncology practices from mailing medications to patients. He explains that legislation has already advanced through committee and now awaits a House floor vote. While conversations with CMS leadership continue, he emphasizes that a legislative solution would provide greater clarity and long-term stability than an administrative reversal, ensuring protections are not undone by future CMS administrations.

Eagle further notes that beyond political action, the oncology community is working to raise awareness about the arbitrary nature of this policy. He stresses that every other entity—from hospitals to PBMs—can mail medications, yet community oncology clinics, which know their patients best, remain barred. With bipartisan support building in Congress, he expresses optimism about the progress of this legislation and the potential to restore patient-centered access to critical therapies.

Pharmacy Times: What unique challenges does this create for patients in rural or underserved communities, where traveling to a clinic or pharmacy may already be difficult?

David Eagle, MD: Well, patients in rural and underserved areas are, of course, disproportionately affected by this restriction because, by definition, if you're in a rural area, you're going to be farther away from the cancer clinic. However, I practice in New York, a fairly urban area. Getting around New York City and Long Island is not easy. You don’t have to be in a rural area to face long travel distances in terms of time and access to your local cancer clinic. It’s definitely more impactful in rural areas, but not exclusively. In many places, including New York, patients have significant transportation barriers, which really get in the way of them getting their medications from the doctor’s office.

Pharmacy Times: What has been the real-world impact of this policy on community oncology practices, both operationally and financially?

Eagle: I'm not the financial person in our practice. I think every practice has to cope with this issue a little bit differently. We have an excellent pharmacy operations team as part of our practice. We have six or seven on-site pharmacies with highly trained pharmacists who integrate care through medically innovative, integrated dispensing. This restriction just adds another layer of uncertainty and complexity in managing patients, because often we don’t know until we get going which patients are truly willing to come and pick up their medications at our office and which ones are not.

When we talk to our pharmacy team, they’ll plan to dispense the medication through the clinic, expecting the patient to come to the office. But we only find out once the process starts that some patients can’t make it. Then we have to pivot, rewrite, and dispense the prescription through the pharmacy benefit manager, which creates delays. Often, the pharmacy benefit manager’s financial assistance programs are not as robust as ours, so it creates another layer of complexity and inefficiency in the system—at a time when being a patient is already hard enough. We want to do everything we can to make it easier, but this just gets in the way.

Pharmacy Times: What steps have COA, OneOncology, and other practices taken to push back against this policy on Capitol Hill?

Eagle: Well, it’s always been clear to the oncology community how harmful and nonsensical this policy has been. Fortunately, many legislatures agree. Representative Diana Harshbarger from Tennessee and Representative Debbie Wasserman Schultz from Florida were the original champions of the Seniors’ Access to Critical Medications Act. That legislation would basically state that it is not a Stark violation for practices to mail drugs to patients. It passed the Energy and Commerce Committee, and we’re now awaiting a floor vote.

We also believe there are ways the current CMS administration could reverse the decision, and we’ve spoken with CMS leadership about this. However, a legislative solution is much clearer and more durable, as it wouldn’t be subject to reconsideration by a subsequent CMS administration.

Beyond the political efforts, we’ve been doing everything we can to raise awareness of this issue. This policy is new and somewhat arbitrary. As mentioned before, everyone else can mail drugs—why can’t the cancer clinic that knows the patient best provide that same service? We believe we’ll find Senate sponsorship this year after it goes through the House, and we feel very good about where we are with bipartisan introduction in the Senate. At the moment, we’re just waiting for this to reach the House floor for a vote.