Why cancer care keeps coming up in strategy conversations this year 

As cancer continues to be a major driver of employers’ health care spend, discussions about how to both manage costs and support employees are becoming increasingly central in health benefits strategic planning. Employers are revisiting their approach to cancer as the signals in their own data — more cases and rising costs — are becoming harder to ignore.

Employers are feeling additional pressure from the upward trend in total health benefit cost growth. Managing high-cost claimants is a top priority, and with cancer care one of the top diagnostic categories of spend, it makes sense to focus on this area specifically. Here are six important considerations for your own conversations:

1. Cancer claims present a persistent cost trajectory that doesn’t respond to quick fixes.

What to do when the trend keeps rising? It’s a straightforward question without a simple answer.

We’ve learned that cancer strategies are most effective when they begin with analyzing the cost and prevalence trajectory using client-specific data. With that information, you can build a multi-year, multi-pronged approach that strengthens prevention, supports earlier detection, improves access to the right care and balances cost management with holistic member support — improving long-term clinical and financial outcomes.

This shift matters because it reframes cancer from a “vendor search” into a data-driven, client-centered ecosystem design challenge. The goal is to address cancer care comprehensively over time, as opposed to expecting a single “cancer point solution” to flip a switch. In practice, employers should understand: What’s in place today? What’s missing? What’s misaligned with our data? What needs to work together over time?

2. Younger ages at diagnosis are changing the employer risk profile.

The types of cancers showing up in employer claims aren’t necessarily new. What’s changing is who is being diagnosed and when.

Employers are seeing more than a dozen forms of cancer, including colorectal, breast, prostate, uterine, stomach and pancreatic being diagnosed in a growing number of men and women under age 50. One forecast predicts cancer incidence in this age group will increase by 30% globally from 2019 to 2030.

Cancer strategies designed primarily for older populations can miss key needs in a working-age population — where family responsibilities, financial stress and caregiving realities look different.

To respond, employers are prioritizing preventive education that resonates with younger employees and reassessing screening coverage and approaches to promote timely detection.

3. Preventive care and cancer screening efforts are being redefined.

Plan sponsors have long invested in prevention and early detection to manage rising costs and improve outcomes, recognizing that fewer late-stage diagnoses can reduce downstream claims expense.

However, generalized screening guidelines and health plan-driven screening campaigns aren’t always tailored to an employer’s specific population demographics. Employer feedback is consistent: restrictions based on age, gender and cost-sharing aren’t helping their cancer screening and early diagnosis strategies.

As a result, many employers are exploring whether they should:

• Cover and communicate HPV for prevention of cervical cancer
• Enhance screening-related benefits
• Reduce actual or perceived barriers to access – cost, time and navigation
• Evaluate whether a cancer point solution can strengthen early detection and screening beyond what the carrier provides or what the employer has tried independently

4. Employers are finding gaps in support they didn’t know existed.

In many cases, the “gap” conversation begins with an uncomfortable discovery: A standard plan design — or a benefit ecosystem setup — that fails to support members at critical moments in the cancer journey.

For example, imaging or a biopsy following a screening mammogram can create out-of-pocket costs that some members did not expect and, in some instances, can’t readily absorb. That can delay follow-up — and potentially delay diagnosis.

One commonly overlooked area is fertility preservation. Cancer treatment can impact fertility, yet these services may be excluded — and employers often don’t realize it until it becomes a crisis for a plan member.

Other opportunities for improvement can be highly specific. Careful analysis of data on disease prevalence and employee demographics, including geographic location, can drive a cancer strategy tailored to the specific pain points in a given population and designed to fill any gaps in benefits or the ecosystem.

5. Quality of care is more complex in cancer because specialization isn’t optional.

Cancer is not a single disease. There are over 200 distinct types of cancer, each with distinct subtypes that have different treatment pathways. Amid the rapid introduction of innovative — sometimes breakthrough — oncology treatments, clinical specialization has become essential.

Employers are looking for solutions that help members connect with the right specialist or subspecialist — someone who understands their specific diagnosis and treatment plan — and paying closer attention to where and how cancer care is delivered.

Centers of Excellence are associated with better outcomes and lower complication rates for some cancers, but the reality is that not every patient needs to receive care at a COE — and for many, staying local is critical. Hybrid models continue to evolve, where much of the care is provided locally while treatment plans are reviewed through remote second-opinion programs and with specialist input.

In the evolving cancer vendor landscape, programs are working to balance access to care, quality of care and cost of care while continuously adapting to rapid advances in science, technology and research.

6. The reality of high-cost cancer drugs and specialty medications.

In the fast-growing market of high-cost cancer drugs and specialty medications, clinical breakthroughs continue to exacerbate the cost of cancer care. Employers are exploring specialty drug management strategies through PBMs and health plans; reviewing utilization management and prior authorization requirements; and evaluating cost-effective site-of-care programs.

Where to start: Strategy before solution

Cancer is not a challenge employers can simply outsource to a single vendor. That’s why there’s so much momentum right now for employer-specific cancer strategies — a structured way to connect the dots across prevention, screening, affordability, care coordination, expert medical opinion, COE access and mental health support. It begins with a step back, to explore your data to understand cancer burden and cost drivers, inventory the current benefits and vendor ecosystem and holistically assess what’s working, what’s missing and what needs to be better aligned to support a multi-year roadmap to a better-performing program.