This research surveyed 110 senior HR and benefits leaders at large, self-funded employers to understand how cancer drug therapy is managed, monitored, and governed. The findings trace a clear pattern: cancer is recognized as the single greatest unmanaged risk, yet it's losing the attention war to GLP-1 drugs and mental health. Leaders are confident they have it covered — 75% say their teams are "very equipped" — but that confidence is built on generalist oversight. Only 6% of employers use specialized oncology experts to review high-cost drug decisions. The result? 70% of employers still haven't bent the cost curve on catastrophic claims. And perhaps most striking: only 16% have ever been approached by an oncology clinic or cancer center with a better way forward.
Over half of HR leaders name cancer drug therapy as their organization's single greatest unmanaged risk over the next three years. Yet when it comes to where executive attention actually goes, cancer consistently loses out to GLP-1 medications and mental health — categories with lower per-member cost impact but far higher media visibility. The result: the costliest line item on the benefits ledger is the one with the least strategic focus.
Q: Looking across your entire organization, what poses the greatest unmanaged risk over the next three years?
Q: How does cancer drug therapy get executive attention compared to GLP-1 and metabolic drugs?
Q: How does cancer drug therapy get executive attention compared to mental health?
Q: Of your top 10 highest-cost claimants last year, how many were driven primarily by cancer drug therapy?
There's a dangerous mismatch between perceived risk and actual attention. Cancer claims dominate the top 10 claimant list — 95% of respondents say 3 or more of their highest-cost claimants are cancer-driven — yet GLP-1 and mental health consistently draw more executive focus. This attention gap means the costliest, most clinically complex category is the one receiving the least strategic oversight at the leadership level.
"Cancer gets more care as the other two have predictable treatment and outcomes."
"It is front and center as it affects employee productivity and costs for the company."
So cancer is the #1 risk but gets less attention. Surely the teams managing it are well-prepared? That's what leaders believe: three-quarters say their teams are "very equipped" to evaluate oncology utilization, and nearly two-thirds report high confidence in their PBM's oncology management. But dig one layer deeper and the foundation cracks. Nearly half say they lack a consistent mechanism to challenge their PBM on cancer drug decisions — and 42% say oncology is managed as part of general specialty pharmacy, not as the clinical specialty it demands.
Q: How equipped is your team to evaluate whether oncology drug utilization is clinically appropriate?
Q: How confident are you that your PBM's oncology management programs align with current evidence-based guidelines?
Q: Do you have the ability to challenge or redirect PBM decisions on high-cost oncology drugs?
Q: How would you describe the way oncology drugs are managed within your PBM relationship?
Confidence without specialized infrastructure is a liability. While 75% say they're "very equipped," 42% simultaneously say oncology is managed as part of general specialty pharmacy — not as a clinical category requiring specialized expertise. And 43% say they only "sometimes," "rarely," or never routinely challenge PBM decisions on high-cost cancer drugs — meaning nearly half of these leaders lack a consistent mechanism to push back when a costly oncology drug is approved without biomarker testing or subspecialist input. Teams feel prepared because they don't know what specialized oversight would reveal.
"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."
Now we know leaders are overconfident — so what's the root cause? It lies in who's actually overseeing oncology drug decisions. Most employers have clinical strategies on paper — biomarker testing, subspecialist review, step therapy — but only 6% use external oncology experts to review high-cost drug choices. The rest rely on medical consultants, pharmacy consultants, or PBMs who may lack subspecialized cancer knowledge. This is the structural gap that false confidence conceals.
Q: What clinical strategies are in place before a high-cost cancer drug gets approved? (Select all that apply)
Q: What percentage of cancer cases actually go through your clinical review processes?
Q: Who reviews whether the high-cost oncology drugs being used align with evidence-based guidelines?
Q: How often do prior authorization processes delay or complicate access to cancer drug therapy?
The expertise gap isn't about missing policies — it's about who's executing them. Over half of respondents say only about half or fewer of their cancer cases actually go through their review processes. Meanwhile, 81% report that prior authorization delays happen occasionally or frequently. And the people doing the reviewing? Medical consultants (36%), pharmacy consultants (35%), and carrier/PBMs (23%) — generalists managing a specialist problem. Only 6% bring in external oncology experts. Without subspecialized oversight, even well-designed guardrails can't catch what they're not trained to see.
"We have some guidelines but much of the decision is still left to individual physician judgment."
"The process is structured, but prior authorizations and formulary rules are frequent bottlenecks that require proactive management to keep therapy on track."
So what's the consequence of misplaced attention, false confidence, and generalist oversight? It shows up in outcomes. Most employers track cancer spend with impressive granularity — 77% have it fully segmented and reviewed regularly. But tracking a problem is not the same as solving it. When asked what their cancer strategy has actually delivered, the results reveal a critical gap between monitoring and managing.
Q: How visible is cancer-specific drug spend within the reporting you receive?
Q: How does your visibility into non-specialty drug spend compare?
Q: How has your cancer care or cancer pharmacy strategy impacted your plan? (Select all that apply)
Only 31% of respondents report actually achieving lower catastrophic claim volatility from their cancer strategy — the one financial outcome that directly impacts plan cost predictability. By contrast, 64% cite "more confidence in therapy appropriateness" and 64% cite "better employee experience." These are meaningful, but they don't address the core actuarial risk. This is the predictable result of the pattern traced through this report: when cancer loses the attention war, gets managed with false confidence, and is reviewed by generalists, the financial outcomes don't move. Employers are watching the fire but struggling to contain it.
"It has optimized our premium expenses. Employee experience has been very good because they are very clear about what the program offers."
The story so far: cancer is the top risk but gets less attention, managed with misplaced confidence, reviewed by generalists, and the cost curve isn't bending. So why hasn't anyone offered these employers a better approach? The data reveals a striking market gap. Governance is fragmented across multiple parties, and 62% of employers have never heard a pitch from any outside source about oncology management. Only 16% have ever been approached by an oncology clinic or cancer center.
Q: Who is responsible for the overall governance of your pharmacy plan?
Q: Do you currently track cancer drug therapy spend separately from your overall reporting?
Q: Have you ever been approached about oncology management by any of these sources? (Select all that apply)
Q: Do you track wellness program participation as its own line item?
This is where the entire report converges. Governance is distributed across multiple parties — plan sponsor, PBM, consultant — but no single entity brings deep oncology expertise to the table. And 62% of respondents have never been approached by anyone about oncology management, while only 16% have ever heard from an oncology clinic or cancer center. These employers have a recognized #1 risk, a gap in specialized oversight, unmet financial outcomes — and nobody has shown them what a purpose-built oncology management solution looks like. The door isn't just open — it's unguarded.
"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 generalist management. AccessHope connects your plan and your employees' community oncologists with NCI subspecialists — bringing the latest evidence-based expertise to every cancer case, without employees leaving home or switching doctors. In 93% of cases reviewed, AccessHope experts recommend improvements. Employers are realizing a 3:1 return on investment.
Learn How AccessHope Can Help →This research surveyed 110 senior HR and benefits leaders at large, self-funded employers to understand how cancer drug therapy is managed, monitored, and governed.
Q: How many employees does your organization have?
Q: In the past 24 months, roughly how many members on your plan have been on active cancer drug therapy?
All respondents hold C-suite, SVP, EVP, or VP titles in Human Resources or People Operations and are primary decision-makers (95%) or significantly involved (5%) in benefits decisions. All report familiarity with pharmacy benefit management and drug spend. Percentages for single-select questions sum to 100%. Multi-select questions (clinical strategies, outcomes, pitches heard) allow multiple responses per respondent and therefore exceed 100% — these are clearly labeled. Quotes are drawn from interviews and are included with permission. Research conducted March 2026.