S11 E1: Fail First, Patients Last? Rethinking Step Therapy in Oncology

With podcast host, Ginger Blackmon, and featuring Lucio Gordan, MD, President and Managing Physician of Florida Cancer Specialists & Research Institute, and Jay Seemann, Vice President of Market Access for BeOne Medicines.

What happens when a payer-required treatment sequence conflicts with the therapy selected by a patient and their oncology care team?

Lucio Gordan, MD, and Jay Seemann join the season 11 premiere to discuss step edit requirements—also known as step therapy or “fail first” policies—and their effects on cancer care.

Dr. Gordan explains the difficult choices practices may face: appeal the requirement and delay treatment, use a therapy the care team considers less appropriate for the patient, or leave the patient with unaffordable costs. He also details the work these requirements create for pharmacists, nurses, advanced practice providers, physicians, financial counselors and revenue-cycle teams.

Drawing from his work in market access and his experience as a caregiver, Jay discusses how manufacturers, payers, policymakers and advocacy organizations can help reduce access barriers. Together, the guests consider how oncology professionals, patients and caregivers can speak up for timely, evidence-based treatment and preserve physician-patient choice.

In this episode:

• How step edit requirements can affect treatment timing and selection
• What the appeals process requires from the oncology care team
• The emotional and financial effects on patients and caregivers
• Policy and advocacy approaches that may reduce treatment-access barriers
• How healthcare professionals and organizations can make their voices heard

Learn More and Take Action

Explore NCODA’s Step Edits in Oncology Hub for educational resources, tools and updates.

Add your voice to NCODA’s Step Edits in Oncology Sign-On Letter as an individual or on behalf of an organization.