This is our advocacy charge for 2025. Despite unanticipated setbacks to close out 2024 with the Senate failure to support allowing oncology practices to mail medications to Medicare patients, and the final Congressional spending package to fund the government omitting critical Pharmacy Benefit Manager (PBM) reforms and a fix to the physician fee schedule, OneOncology enters 2025 with significant political strengths, tools, and achievements.

Key Strengths and Opportunities

OneOncology has a powerful brand on Capitol Hill. Congressional offices know OneOncology partner practice physicians and the positive impact they have on the lives of cancer patients in their communities. Independent oncology practices overall, and OneOncology specifically, provide the healthcare system with what it needs: high-quality, integrated cancer care at the best price.

A recent study commissioned by the American Independent Medical Physicians Association (AIMPA) and conducted by Avalere, which is discussed further in another section, underscores OneOncology’s strengths. OneOncology consistently engages with policymakers on Capitol Hill, thanks to the involvement of physicians and administrators who participated in 2024 advocacy trips. Doubling down on efforts to educate legislators, payors, and others is essential in 2025 as we expand awareness about the value the OneOncology business model creates.

AIMPA: A Key Asset

OneOncology was a founding member of AIMPA, a national coalition that now boasts over 10,000 physician members. AIMPA focuses on promoting the value of independent medicine through engagement with Washington and in the media. AIMPA’s Avalere data study, which studied Medicare spending and healthcare utilization across four physician practice models in five specialties, exceeded expectations by demonstrating the superior quality and value of private equity-backed MSOs.

AIMPA has also supported the development of state-level independent practice associations which have become critical advocates in statehouses across the country.

PBMs: A Fight Far from Over

Although PBMs won in the year-end congressional spending package, their position remains tenuous. The disrupted package had included significant reforms: any-willing-provider provisions, bans on rebate structures tied to drug prices, and requirements to pass discounts to employers and health plans. President Trump has emphasized the need to eliminate PBMs as middlemen. PBMs cannot avoid scrutiny much longer; their practices are widely criticized, and public trust is minimal.

In New York, newly finalized Pharmacy Benefits Bureau rules provide a model for other states. These rules protect against contract manipulation, promote open networks, and prevent patient steering. They also require equal reimbursement for network and PBM-affiliated pharmacies and explicitly allow drug mailing. We specifically emphasized the drug mailing provision in recent discussions with Senate Minority Leader Chuck Schumer’s staff.

Battling Below-Water Reimbursement

PBMs have pivoted to below-water drug reimbursements following challenges to Direct and Indirect Remuneration (DIR) fees. While existing rules prohibit this, CMS has failed to enforce them, citing a non-applicable non-interference clause. Both the House and Senate have called on CMS to intervene, and we anticipate progress with a new CMS administrator next year.

Drug Price Negotiations

The Inflation Reduction Act (IRA) introduced drug price negotiations in 2024, though the process remains flawed. CMS limits the factors manufacturers can present to justify prices, excluding critical expenses like research and development for failed drugs—the industry’s largest cost. Over time, more drugs will fall under these restrictions, creating significant cumulative effects.

For oncology, the IRA presents a unique challenge: reimbursement will shift from the average sales price to the maximum fair price, drastically reducing reimbursement. Senator John Barrasso (R-Wyoming) leads an effort to find a technical fix, and with Republican control of all three branches of government, Democrats now seem open to revising the law. This issue will be critical in 2025, with new prices taking effect in January 2026.

Physician Payment Reform

After decades of stagnation, physician payment reform is finally gaining traction. The physician fee schedule has been flat for over 20 years, failing to keep pace with inflation and contributing to significant reimbursement declines compared to hospital payments. A Senate working group is addressing both reimbursement amounts and structural issues, including the burdensome MACRA/MIPS framework.

While 2025 begins with a fee schedule reduction, there is hope for a fix by March, potentially with retroactive payment adjustments. OneOncology will remain actively involved in these discussions to support necessary changes.

340B Reform

The 340B program continues to provide a significant advantage to non-profit hospitals, especially in oncology, with discounted purchases exceeding $60 billion in 2023. OneOncology submitted a 340B Request for Information to a bipartisan Senate working group which has drafted comprehensive reform legislation. While this proposal remains unreleased, it would bring needed structure to a program that has evolved haphazardly over decades.

The Loper Bright Supreme Court decision has increased scrutiny on programs shaped by administrative actions, creating additional vulnerability for 340B. While reform is essential, many hospitals are financially dependent on the program, complicating efforts to enact change.

Looking Ahead

Despite the end-of-year disappointments, 2024 was the most positive legislative year in decades for independent oncology. Issues that were previously ignored are now squarely on the table. OneOncology’s business model addresses the core challenges of today’s healthcare system. Policymakers recognize our value, and our platform is a proven solution.

As Margaret Thatcher’s words advise, we must regroup to fight our battles again this year. Together, we can shape the future of healthcare and continue to deliver high-quality, patient-centered care. Let’s move forward with determination and optimism.