More than half of HR and benefits leaders name cancer drug therapy as their greatest unmanaged risk over the next three years. Yet when it comes to where executive attention actually goes, cancer consistently takes a back seat to GLP-1 medications and mental health — categories with lower per-member cost impact but far greater visibility. Looking back, the industry was slow to respond to the GLP-1 wave — coverage among the largest employers jumped from 28% to 43% in just one year, only after costs had already surged (KFF 2025 Employer Health Benefits Survey). This survey suggests we may now be just as late in responding to the growing cancer burden.
Cancer dominates the top 10 highest-cost claimant list, with 95% of respondents reporting that three or more of their most expensive claimants are cancer-driven. Yet 62% say GLP-1s receive more executive attention, and 55% say the same about mental health. In total, 94% say GLP-1s receive the same or more attention than cancer. This is not a case of competing priorities — it is the costliest clinical category being structurally overshadowed at the leadership level.
"It is front and center as it affects employee productivity and costs for the company."
Employers report high confidence in their oncology management capabilities — 74% say their teams are "very equipped." But nearly half treat oncology as part of general specialty pharmacy rather than a distinct clinical category. Limited market engagement reinforces this dynamic: 62% of employers said they have never discussed options for oncology-specific management services, and only 16% have ever been approached by a cancer center directly. Those providing guidance today do not have subspecialty expertise in oncology.
Confidence without specialized infrastructure is a liability. Among those who say they are "very equipped," 36% still manage oncology within general specialty pharmacy. Only 6% of employers use external oncology experts to review high-cost drug decisions. The rest rely on medical consultants (36%), pharmacy consultants (35%), and carriers or PBMs (22%) — professionals without subspecialty oncology expertise managing a problem that demands it. At the same time, more than half of respondents say only about half or fewer of cancer cases go through formal clinical review. And with 62% having never discussed oncology-specific management options, many employers don't realize the gaps in their current approach.
Employer approaches vary widely — from reactive to proactive — and that variation is itself part of the problem. Without a consistent standard, the quality of cancer management often comes down to individual philosophy rather than systematic oversight.
"We don't do this on a case-by-case basis except when there are a number of employee complaints."
"We go with oncology experts' recommendations. In some cases costs are higher but we are more human-centric."
77% of employers report strong visibility into cancer spend, with costs fully segmented and reviewed regularly. But tracking a problem is not the same as solving it. Only 31% report success in reducing catastrophic claim volatility, the outcome that most directly impacts plan performance. As a result, nearly 70% of employers continue to face volatile, unpredictable cancer claims despite close monitoring. At the same time, 81% report that prior authorization processes frequently or occasionally delay access to cancer drug therapy — a concrete workflow barrier that helps explain why visibility alone is not translating into better outcomes.
This is the predictable result of the pattern traced throughout this report. When cancer loses the attention war, is managed without subspecialty oncology expertise, and is reviewed by professionals without training in current treatment protocols, financial outcomes do not improve. While 64% report increased confidence in care decisions and a better employee experience, these gains are not translating into measurable financial impact. Fewer than one in three employers are reducing catastrophic claim volatility, the metric that most directly affects plan cost predictability. Meanwhile, 42% say they cannot routinely challenge PBM decisions on high-cost oncology drugs, limiting the effectiveness of existing guardrails.
"The biggest challenge is balancing access to the most effective treatments with the high and rapidly rising cost of cancer drugs. Many therapies are very expensive and treatment plans can be complex."
"Success would mean faster approvals, evidence-based guidance to oncologists upfront."
The data is clear: employers need specialized oncology oversight, not more management without subspecialty expertise. AccessHope connects your plan and your employees' community oncologists with subspecialists from National Cancer Institute-Designated Cancer Centers, bringing the latest evidence-based expertise to every cancer case without requiring employees to leave home or switch doctors.
AccessHope is transforming cancer care in the workplace through a unique employer-sponsored benefit that provides expert-driven cancer support, including treatment review, molecular tumor analysis, and clinical trial matching. In 93% of cases reviewed, AccessHope experts recommend improvements.
Learn How AccessHope Can Help →This research was designed to capture how large, self-funded U.S. employers manage, monitor, and govern cancer drug therapy within their health plans. The study was conducted in March 2026 via the Gather research platform.
Respondents were recruited from a nationally representative online panel of U.S. business professionals. All participants were screened and verified to meet eligibility criteria: C-suite, SVP, EVP, or VP title in HR or People Operations; employed at a self-funded organization with 5,000+ employees; primary decision maker or significantly involved in benefits decisions; and self-reported familiarity with pharmacy benefit management and drug spend. Fieldwork was conducted March 19–23, 2026. Median completion time was approximately 12 minutes.
All 110 respondents hold C-suite, SVP, EVP, or VP titles in Human Resources or People Operations and were independently screened for familiarity with pharmacy benefit management and drug spend. Ninety-five percent are the primary benefits decision maker at their organization. The remaining 5% are senior HR and People Operations leaders who directly participate in benefits strategy, vendor evaluation, and plan design — fully qualified to speak to how their organization manages cancer risk.
All 110 respondents hold senior HR or People Operations leadership titles. The sample skews toward mid-to-large employers (5,000 to 9,999 employees), reflecting the segment most actively managing specialty pharmacy risk. A majority reported managing active cancer drug therapy cases for six or more members over the prior 24 months.
All responses were cleaned and de-duplicated prior to analysis. Percentages for single-select questions are calculated from the total respondent base (N=110) and sum to 100% with standard rounding. Multi-select questions allow multiple responses per respondent and may therefore exceed 100%; these are clearly labeled throughout the report. Verbatim quotes are drawn from open-ended survey responses and are included with respondent permission. No personally identifiable information was collected.
This study relies on self-reported data from a convenience sample of HR and benefits leaders recruited through an online panel. Results reflect respondent perceptions and may not represent the full population of large self-funded employers. Sample size (N=110) supports directional findings but may not support subgroup analysis at statistical significance. All data was collected at a single point in time.