Oncology access is tightening as payer controls expand, creating delays and higher abandonment of treatment. Between 2020 and 2024, formulary exclusions for oncology products grew from 37 to 134, mainly impacting oral therapies and even physician-administered drugs. Over 75% of cancer patients face initial rejections, with only 10% of Commercial and 23% of Medicare patients approved on their first attempt. Retail pharmacies show the highest rejection and abandonment rates—up to 64% in Medicare—while medically integrated and specialty/mail sites improve initiation. Financial support is critical: without it, 76% of Medicare patients pay $500+ per prescription, and abandonment rises tenfold.

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