With major reimbursement and coverage changes occurring in 2026, oncology practices are closely watching federal policy developments that could affect everything from prior authorization workflows to drug reimbursement and patient coverage stability. At the Association of Cancer Care Centers (ACCC) Winter 2025 Virtual Oncology Reimbursement Meeting, Nicole Tapay, ACCC’s director of cancer care delivery and health policy, outlined the organization’s key federal advocacy priorities and highlighted policy updates cancer programs should be prepared for.
Designed for members of the cancer care team involved in oncology business, reimbursement, and program operations, the virtual meeting focused on helping practices stay ahead of rapidly evolving federal policy and payment changes.
Prior Authorization Topped ACCC’s 2025 Agenda
Prior authorization was ACCC’s top federal priority in 2025, Ms Tapay said, reflecting growing concern among providers about delays in care and administrative burden.
“Prior authorization is the process by which providers have to get, and patients have to get, preapproval from their insurance company or payer for certain services or medication,” she said. “It is an area, frankly, of some growing frustration on the part of the providers, given the time and delays that are involved.”
ACCC has advocated for passage of the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would apply to Medicare Advantage plans. While limited in scope, Ms Tapay said the bill could represent meaningful progress if included in a year-end congressional package.
A broader regulatory change—a prior authorization rule finalized under the previous administration—took effect January 1 and applies not only to Medicare Advantage but also to Medicaid, the Children’s Health Insurance Program, and certain Affordable Care Act (ACA) exchange plans. The regulation establishes turnaround time requirements for coverage decisions, along with transparency and electronic process standards.
“It will be interesting to see if there’s a reduction in concern as a consequence of the implementation of that regulation,” Ms Tapay said.
She also noted voluntary commitments from the insurance industry, made in coordination with the administration, to improve prior authorization processes. ACCC plans to monitor whether those pledges lead to measurable improvements for providers.
However, a major gap remains. None of the legislative or regulatory efforts apply to employer-sponsored insurance plans, which cover a large portion of Americans under age 65.
“That is an area where further progress would be needed,” she said.
Medicare Drug Price Negotiation Raises Practice-Level Concerns
Ms Tapay also addressed implementation of Medicare drug price negotiation under the Inflation Reduction Act. In 2025, Medicare announced negotiated prices for the first 10 drugs, including 1 oncology medication. An additional 15 drugs have been selected for negotiation for the following year, 4 of which are oncology therapies.
To date, ACCC members have not seen direct effects on their practices because negotiated prices have not yet taken effect. However, ACCC is closely watching upcoming negotiations involving Medicare Part B drugs, she added.
“One area we’re watching, with some grave concern, is the Part B negotiations,” she said. “Under the formula, it is likely that the reimbursement for providers who administer oncology medicines will be reduced.”
ACCC has communicated its concerns to the Centers for Medicare & Medicaid Services, providing data and outlining potential impacts on both providers and patients if reimbursement reductions are not carefully managed.
Financial Toxicity and Coverage Stability
Ms Tapay highlighted financial toxicity as another key focus for ACCC, describing the financial strain patients and caregivers often face even when insurance coverage is in place.
“Even when people have coverage, there is frequently a lot of copayments, as well as additional costs, such as travel or hotel, if they’re getting treated outside of their home area,” she said.
Several policy developments could worsen coverage instability in the coming years. Changes included in the One Big Beautiful Bill Act introduce work requirements and additional administrative hurdles for Medicaid eligibility that are projected to reduce the number of insured individuals by more than 5 million when implemented in 2026.
“This would actually mean that people who are on Medicaid may lose their coverage altogether,” she said.
At the same time, the future of enhanced ACA subsidies remains uncertain. If Congress does not act to extend them, many patients could face higher premiums or lose coverage entirely.
Patient Navigation and Drug Shortages
Ms Tapay pointed to progress in patient navigation, noting that Medicare has now allowed payment for navigation services for 2 years.
“For the first time, Medicare has allowed for payment of those services, which essentially help patients as they make their way through the system,” she said.
Many oncology centers have successfully implemented patient navigation programs, though ACCC continues to monitor for implementation challenges.
Drug shortages also remain a concern. While shortages are not as severe as in prior years, Ms Tapay said ACCC is continuing its work with a multistakeholder coalition to address systemic causes.
“We’re not seeing it at the same level of severity,” she said, “but unfortunately, there continues to be drug shortages.”
Policy Priorities in 2026
Ms Tapay closed by outlining several areas that will remain priorities for ACCC, including Medicaid coverage losses, potential expiration of ACA subsidies, and telehealth flexibilities that are currently set to expire at the end of January.
ACCC is also backing legislation to address step therapy requirements, monitoring workforce shortages that may be exacerbated by immigration policy changes, and watching for potential downstream effects of Medicare drug price negotiation on provider reimbursement. In addition, she cited concern about recent cuts to federal research funding and their impact on clinical trials, as well as continued advocacy around cancer screening legislation, including efforts supporting multicancer early detection testing.
“We remain reactive and responsive to anything that is happening in the policy environment that impacts our members and the patients that they serve,” she said.
Ms Tapay emphasized that staying engaged with federal policy developments will be critical for cancer programs seeking to anticipate reimbursement changes, protect patient access, and sustain oncology care delivery.