AMCP Nexus 2025 Summary

Laura R. Bobolts, PharmD, BCOP - Senior Vice President, Clinical Strategy and Growth, OncoHealth, Pompano Beach, FL

Introduction

Nearly 3,000 managed care pharmacists attended the Academy of Managed Care Pharmacy (AMCP) Nexus conference in October 2025. AMCP represents pharmacy leaders across health plans, pharmacy benefit managers (PBMs), specialty pharmacies, and pharmaceutical manufacturers. This year’s meeting focused on health policy, Medicare and Medicaid regulations, PBM reform, real-world evidence, and specialty medications - areas where oncology continues to generate significant attention.

Below are key oncology-focused managed care sessions from AMCP Nexus 2025, highlighted for HOPA members.

Radiopharmaceuticals in Cancer Care

A featured session, “All Aglow! Health Plan Challenges and Opportunities with the Rise of Radiopharmaceuticals in Cancer Care,” explored the expanding role of radiopharmaceuticals in oncology. Presenters Abby Kim, PharmD, BCOP, and Sneha Sharma, PharmD, discussed the anticipated multibillion-dollar growth in radiopharmaceutical utilization, with spending expected to double over the next decade. The session highlighted the expanding use of both diagnostic and therapeutic radiopharmaceuticals, especially in prostate cancer. It also emphasized the need for managed care strategies to address costs, utilization management, and adverse-effect monitoring.

This topic was especially timely, as managed care pharmacists are finding themselves increasingly navigating the rising spend associated with therapeutic radiopharmaceuticals as well as diagnostic tracers, an area of growing payer interest with a limited management framework today.

Real-World Evidence and CAR T-Cell Therapy Access

The session “Creating Sustainable Solutions for Enhancing CAR T-Cell Therapy Access” brought together payers, clinicians, and data experts to discuss strategies for improving access to CAR T-cell therapies. Presenters Andy Berg, PharmD; Chester B. Good, MD, MPH; Robert O’Brien, RPh; and Ryan Steadman, PharmD, highlighted how real-world data can support payer decision-making, refine utilization criteria, and identify high-performing treatment centers.

Persistent barriers to CAR T access were discussed, including high costs, limited coverage, geographic disparities, and the concentration of care at FACT-accredited centers. One example of a barrier was highlighted in patients within the UPMC system who were unwilling or unable to travel to Pittsburgh for cellular therapy consultation. While payers initially expressed concern over the FDA’s removal of Risk Evaluation and Mitigation Strategy (REMS) requirements for CAR T-cell therapies, there is optimism that this change may help expand access. Ongoing monitoring of real-world outcomes and costs remains critical to supporting earlier referrals and promoting more equitable access.

Precision Medicine and Managed Care Perspectives

A major educational session, “Precision Medicine 101: The Role of Managed Care in Bridging Coverage Gaps,” examined how precision medicine continues to reshape oncology care. Speakers Jennifer Billings, PharmD, BCGP, and Steven Kheloussi, PharmD, MBA, FAMCP, emphasized that precision therapies now account for over 60% of oncology drug approvals in the past five years. Appropriate biomarker testing and treatment selection were highlighted as essential to improving outcomes, particularly in diseases such as non-small cell lung cancer.

From a managed care perspective, precision medicine involves a complex ecosystem of stakeholders, including payers, employer groups, policy vendors, laboratory benefit managers, and oncology utilization management organizations. The session also addressed the evolving roles of next-generation sequencing (NGS), companion diagnostics, and laboratory-developed tests, as well as with state-specific coverage mandates and differences across insurance lines of business (commercial, Medicare, and Medicaid). NGS coverage is expected to face new challenges in 2026 as therapies requiring repeat liquid ctDNA NGS monitoring for molecular progression, such as camizestrant, potentially enter the market.

If you missed AMCP Nexus, don’t worry: AMCP hosts two national meetings each year. The AMCP 2026 annual meeting will be in Nashville, TN on April 13-16, and AMCP Nexus 2026 will take place on October 26-29 in San Diego, CA. I hope to see you there!

References

1.Kim A, Sharma S. All Aglow! Health Plan Challenges and Opportunities with the Rise of Radiopharmaceuticals in Cancer Care. AMCP Nexus 2025. October 27-30, 2025.

2.Berg A, Good CB, O’Brien R, Steadman R. Creating sustainable solutions for enhancing CAR T-cell therapy access: technology and site of care solutions to improve outcomes and reduce health disparities. AMCP Nexus 2025. October 27-30, 2025.

3.Billings J, Kheloussi S. Precision Medicine 101: The Role of Managed Care in Bridging Coverage Gaps. AMCP Nexus 2025. October 27-30, 2025.