Turning the page: Projections for cancer care in the coming year

As 2024 approaches, it’s anyone’s guess whether an already complex health care ecosystem gets to turn the corner on the mixed legacies of 2023—including record high prices on new blockbuster medications coupled with drug shortages on existing generics, persistent staff shortages and battered hospital margins, and a continued emphasis on value-based care programs by insurers. 

Here’s what I predict to be in store for 2024 in oncologic care:

We’ll finally see pushback against pharmacy benefit managers (PBMs)

Three pharmacy benefit managers dominate 80% of the market, and have become so conflicted within their incentive structure that their involvement leads to higher—not lower—drug prices.

Much needed reform is well past due, and I believe that 2024 is the year that the penny finally drops on PBMs. 

The signs are already there: Earlier this year, the FTC deepened probes into PBMs that began in 2022. Multiple lawsuits were also recently initiated by independent pharmacies and states’ attorney generals, accusing PBMs of collusion and deceptive business practices. 

And now, bipartisan legislative efforts are advancing in the House and Senate to enforce greater transparency and to control profiteering. By the end of 2024, I expect that we will see more transparency of PBM rebate structure—communicated to pharmacies upfront and diminished copay manipulation that steers consumers to higher-cost, brand-name drugs where equivalent, cheaper generics exist.