{
  "abstract": "Step therapy (“fail-first”) policies require patients to initiate treatment with a payer-preferred regimen, often selected for cost, before coverage is granted for the oncologist-recommended therapy. In medical oncology, where biologic heterogeneity, biomarker-directed therapy, and time-sensitive sequencing determine outcomes, step edits can function as an avoidable barrier to evidence-based care. We performed a narrative review of peer-reviewed literature (2010-2025) and relevant US regulatory and policy documents to summarize the clinical, economic, and equity implications of step therapy as applied to systemic anticancer treatments. Evidence from cancer-specific and cross-cutting utilization management research suggests that coverage restrictions can delay initiation or continuation of therapy and increase treatment discontinuation. We synthesize mechanisms of harm (time-to-treatment delays, forced non-guideline-concordant sequencing, and toxicity exposure), describe contemporary case examples across therapeutic areas, and propose actionable policy remedies. Oncology-specific safeguards, including transparent clinical criteria, rapid exceptions and appeals, continuity-of-care protections, and provider performance-based exemptions (“gold-carding”), are essential to balance payer oversight with the imperatives of precision oncology.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "Lucio N Gordan"
    },
    {
      "name": "Kristen Boykin",
      "orcid": "0009-0008-0863-7547"
    },
    {
      "name": "Michael Reff"
    },
    {
      "name": "Paul Chadwick"
    },
    {
      "name": "Kiana Mehring"
    },
    {
      "name": "Austin Cox"
    },
    {
      "name": "David Wenk"
    },
    {
      "name": "Matthew Fink"
    },
    {
      "name": "Josh Eaves"
    },
    {
      "name": "Ryan Ciarrocchi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4magw0c0jaavf.bib",
  "cited_by": 0,
  "doi": "10.1093/oncolo/oyag398",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13716484/",
  "id": "4magw0c0jaavf",
  "issns": [
    "1083-7159",
    "1549-490X"
  ],
  "landing_url": "https://doi.org/10.1093/oncolo/oyag398",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00010"
    ],
    [
      "heading",
      "Health Outcomes and Economics of Cancer Care"
    ],
    [
      "heading",
      "Review Article"
    ],
    [
      "openalex",
      "2002|Economic and Financial Impacts of Cancer"
    ]
  ],
  "openalex": "W7221514106",
  "pdf_url": "https://academic.oup.com/oncolo/advance-article-pdf/doi/10.1093/oncolo/oyag398/71869316/oyag398.pdf",
  "pmcid": "PMC13716484",
  "pmid": "42861726",
  "published": "2026-10-12",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/4magw0c0jaavf.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:23:25Z",
      "native_id": "PMC13716484",
      "source": "pmc",
      "url": "https://doi.org/10.1093/oncolo/oyag398"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "The perils and consequences of payer step editing (“Step Therapy”) in US medical oncology: evidence, case examples, and policy remedies",
  "title_text": "The perils and consequences of payer step editing (“Step Therapy”) in US medical oncology: evidence, case examples, and policy remedies",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:23:25Z",
  "url": "https://research.draconitic.com/paper/4magw0c0jaavf",
  "venue": "The Oncologist",
  "versions": []
}