Oncology is the most significant focus of research activity and capital deployment, making up 36% of all new US drug approvals in 2024. Yet, new market forces in US oncology demand earlier and more strategic account activation for successful drug launches and commercialization.
To pinpoint how these market forces are changing cancer care, EY researchers polled over 60 cancer care experts as part of the annual Provider Pulse Survey and identified four key trends that are imperative for manufacturers to include in their activation strategies.
Trend 1: Accelerating consolidation and corporatization of cancer care
Consolidation in US oncology is increasing, spurred by the attractiveness of the “buy and bill” margins and driven by the need to achieve scale and maintain sustainable operations in the wake of rising administrative burdens. The EY Provider Pulse Survey indicates that almost half of all consulted oncologists were changing the financial structure of their practice, such as partnerships with other, larger practices or mergers with hospital systems. Numerous oncologists indicated an increasing likelihood of joining an oncology “super group” to gain access to pooled management services, enhanced infrastructure, and clinical and financial tools to remain solvent and competitive in their markets.
Oncology practice ownership consolidation trends 2024
Corroborating this consolidation trend is the fact that over 70% of oncologists are now aligned with a hospital or a health system and a growing number of oncology clinics are affiliated with PE-backed companies.
This level of consolidation requires pharma to shift focus from traditional engagement models targeting independent oncology offices and academic medical centers (AMCs) to engaging with large oncology super groups, which have significant market power and operate with a corporate mindset. Consolidation also presents an opportunity for drug manufacturers to transition from a broad-based, provider-centric approach to a focused, strategic account activation strategy, including customized programs and value-based offerings.
Trend 2: Move toward precision medicine
The US oncology landscape is shifting dramatically thanks to the rapid advancement and deployment of precision medicine. Novel diagnostic tools and molecular profiling technologies are enabling clinicians to tailor cancer therapies to the unique genetic makeup of individual patients, moving away from the traditional one-size-fits-all approach.
This shift is accelerating the emergence of multidisciplinary care teams, as oncologists work more closely with pathologists, genetic counselors, data scientists and pharmacists specializing in precision oncology. The complexity introduced by these innovations demands greater collaboration not only in clinical decision-making but also in navigating payer policies for advanced diagnostics and targeted therapies. As cancer care becomes more personalized, the expectations of pharma are evolving; manufacturers must now provide data-driven insights and real-world evidence that demonstrate the clinical and economic impact of their therapies in highly specific patient populations.
Moreover, the rapidly changing reimbursement landscape for precision medicine, including variable coverage for genomic tests and prior authorization requirements for certain targeted therapies, means that manufacturers must support accounts with up-to-date information on payer policies and help guide providers through increasingly intricate approval processes as well as operational implications of working with external lab partners. Early engagement with both clinical and administrative stakeholders can help position new products to expand patient access and deliver meaningful outcomes.
Trend 3: Operational transformation of cancer care delivery
While clinical and technological advantages continue to improve cancer care, the economics of oncology practice in the US is also undergoing a dramatic shift. While the adoption of new oncology care models has been low, providers have focused on operational transformation to advance value creation and enhancement. The expected Part B Maximum Fair Price (MFP) effectuation of key oncology agents will further advance this trend. To optimize the cost-effectiveness of care delivery, providers are increasing their use of both artificial intelligence (AI) and advanced practitioners in oncology. The role of nurse practitioners and physician assistants is expanding into patient education and counseling (in person or via telemedicine), symptom management and care coordination.
Pharma should undertake comprehensive pre-launch market conditioning initiatives to inform providers about workflow changes, operational implications and reimbursement dynamics well in advance of launch. Furthermore, impactful account activation strategies should incorporate advanced practitioners alongside oncologists and adjust to the evolving role of AI within the operational aspects of cancer care delivery.
Trend 4: Rising number of clinical pathways
The adoption of clinical pathways is increasing in US oncology due to the complexity, cost and variability associated with cancer care. Key applications include standardizing treatment based on evidence for new therapies, biomarkers and combinations; customizing therapy choices for specific patient conditions; and using AI-powered decision support tools integrated with electronic health records (EHRs) for point-of-care guidance.
From an account activation perspective, oncology drug manufacturers are now expected to demonstrate both clinical and economic value to achieve favorable pathway placement at launch. Additionally, effective account activation should incorporate patient-centric data at the subpopulation level and show how a product addresses individual patient needs within shared decision-making processes.
Activating accounts at scale
While the above-outlined trends are incentivizing pharma companies to take an increasingly account-based activation approach, capability and competency gaps in account-level planning and execution often make it difficult (or impossible) to strategize for each account individually.
Account engagement optimization approach
It is, therefore, critical to group accounts with similar behaviors (e.g., research focus, level of control, infusion suite capacity) into archetypes. With this approach, key business questions and strategies will be the same for accounts within the same archetype, but the tactics required and the level of activation effort will depend on each account’s maturity and performance.
Next frontier in customer engagement and acceleration: account activation
To succeed in oncology, pharma must engage in market-shaping, launch-planning and lifecycle management activities that go beyond the traditional provider engagement and reconsider whom to engage, how to engage and what to engage on.
Whom to engage
In this year’s Provider Pulse Survey, oncologists indicated engaging most regularly with sales reps and medical scientific liaisons. Relative to the 2024 survey results, providers are increasingly interacting with account managers, reimbursement specialists and patient support specialists. In fact, connections with these roles increased substantially year over year, while interactions with sales reps continued to decline.
While providers are seeking medical information and scientific exchange, they are also looking to navigate reimbursement and patient affordability topics. Therefore, pharma needs to build cross-functional teams across medical, sales, access and reimbursement that collaborate across customer touch points within an account and can address a broad range of emerging provider-relevant topics such as reimbursement optimizers, local coverage dynamics and novel clinical pathway integration.
How to engage
Oncologist preferences indicate a significant opportunity for online and digital engagement via channels such as virtual sessions and webinars.
HCP communication and engagement preferences with biopharma representatives 2024
While virtual interactions cannot replace the in-person engagement from a pharma perspective, this oncologist feedback highlights that the need for customer-tailored engagement for in-person access, augmented by additional channels and content, is now more pronounced than ever.
What to engage on
Finally, the EY Provider Pulse Survey also highlighted that oncologists value pharma’s investment into patient access and information resources, clinical product details and reimbursement.
Preferred engagement materials: Helpfulness of materials
These findings dovetail with the previously discussed future trends in the US oncology space, including an increasingly opaque and uncertain coverage and reimbursement environment, as well as a growing focus on precision medicine and on increasingly used oncology care pathways.
The transition to account-based engagement will continue; consolidation shows no signs of slowing down. However, a one-size-fits-all approach is outdated and will not help companies that are currently failing to address account-based customer needs.
To unlock the significant opportunities in the US oncology space, pharma will need to implement account-based go-to-market strategies, invest in account planning for key accounts and execute with cross-functional engagement approaches and teams.
By leveraging insights from the EY Provider Pulse Survey, companies can proactively shape the future of account activation so they can effectively capture and respond to oncologist needs.
The urgency to act is clear. Don’t wait — transform your engagement strategy today and seize the opportunities that lie ahead.
Article authored by Ernst & Young LLP professionals: Muna Tuna, Commercial and Market Access Leader; Eduardo Schur, Commercial Strategy and R&D Leader; and Emil Nedev, Senior Manager.
The views reflected in this article are the views of the author and do not necessarily reflect the views of Ernst & Young LLP or other members of the global EY organization.