Community Oncology Alliance Reacts to Final 2026 Medicare Physician Fee Schedule

Final Rule Offers Some Relief for Community Oncology, but Equitable Payments and Continued Policy Stability Needed to Protect Patient Access

WASHINGTON, DC, UNITED STATES, November 19, 2025 /EINPresswire.com/ -- The Community Oncology Alliance (COA) commends the Centers for Medicare and Medicaid Services (CMS) for taking several positive steps in the final 2026 Medicare Physician Fee Schedule (PFS) and urges the agency to continue leveling the playing field for independent community oncology practices after five straight years of payment cuts to physician-run practices. At the same time, COA is disappointed that CMS did not adopt many of the recommendations submitted in COA’s formal comments on the proposed rule that could have strengthened the position of independent practices and patient care.


COA Analysis of Payment Rate Changes and Impact on Community Oncology

Beginning in CY 2026, there will be two separate conversion factors (CFs): one for participants in Alternative Payment Models (APMs) and another for non-APM practices.

The final conversion factor increases of +3.26 percent for non-APM practices and +3.77 percent for APM practices reflect the one-time +2.5 percent physician pay increase approved under the One Big Beautiful Bill Act. This temporary increase offers important short-term support. However, without further congressional action, it will expire on January 1, 2027, resulting in an automatic payment reduction.

Using community oncology practice data, COA conducted an oncology-specific impact analysis of the final rule. It found that the overall impact of the final 2026 PFS to non-APM multi-specialty practices is about a +7.51 percent payment increase across services.

Relative value unit (RVU) changes in the 2026 PFS vary across CPT codes, which result in the following approximate impacts for key specialties and service combinations:

- E&M and Infusion only: +9.44 percent
- E&M, Infusion, Radiation and Imaging: +7.68 percent
- Infusion, Radiation and Imaging: +6.25 percent
- Imaging services overall: +0.72 percent

The RVUs associated with imaging codes had the most decreases. And, when the +2.5 percent statutory adjustment of the One Big Beautiful Bill Act expires at the end of 2026, imaging services are all projected to decline by approximately -1.75 percent relative to current rates.

The 2026 policy changes around patient navigation reinforce and financially support the core strengths of community oncology: personalized navigation, continuous care management, and real-time monitoring. The primary benefit for practices is reimbursement that more accurately reflects the work they already perform, strengthening both sustainability and the patient experience.


Impact of Including Maximum Fair Price (MFP) in Average Sales Price (ASP) Calculations and Ending Publication of ASP for Selected Drugs

While the 2026 PFS includes several positive developments, other provisions create significant headwinds for independent practices. These stem from the implementation of Maximum Fair Price (MFP) for drugs selected for negotiations under the Inflation Reduction Act (IRA).

The most damaging 2026 PFS policy finalized by CMS is the decision to include units sold at MFP into ASP. This will artificially depress ASP, impacting commercial and Medicare Advantage practice reimbursement. Prior analysis estimates that average add-on payment may decline by 39 percent in Medicare Fee-For-Service and 13% in Commercial and Medicare Advantage. For practices acquiring high-cost cancer therapies on thin margins, this presents unsustainable pressure.

In addition, the 2026 PFS finalized CMS’ decision to stop publishing ASP for drugs once MFP applies, instead publishing only the MFP in quarterly pricing files. This affects contracts and reimbursement arrangements tied to ASP, as the public source will no longer reflect the true market-based ASP. This change will create incredible operational upheaval and economic uncertainty for practices and payers.


“Efficiency Adjustment” Changes Reduces Value of Physician Work Time

In the 2026 PFS, CMS also introduced an “efficiency adjustment” that reduces reimbursement for certain non-time-based services. CMS will reduce the physician work time component of the payment calculation by 2.5 percent in 2026 for services subject to the efficiency adjustor. Exemptions include E&M visits, care management, behavioral health, and time-based drug administration.

While the “efficiency adjustment” is meant to reflect productivity gains from new technology and workflows, in reality it penalizes oncologists for spending time with patients to address their complex health needs and concerns.

“While we applaud CMS for several adjustments that will help correct years of cuts for community oncology, more must be done to ensure the continued ability of practices to treat patients,” said Ted Okon, COA’s executive director. “Community oncology is the backbone of the U.S. cancer care system, with practices treating more than half of all patients with cancer. If CMS is not careful, it risks broad destruction of the independent provider system that delivers high-value, high-quality, and the most affordable cancer care close to where patients live and work.”

COA remains committed to working constructively with CMS and Congress to ensure stable, sustainable reimbursement policies that safeguard patient access to high-quality, affordable cancer care in the community setting.


Resources for COA Members and Community Oncology Practices

Earlier this month, COA hosted a detailed webinar providing an in-depth walkthrough of the final 2026 PFS rule, its impacts, and practical implementation steps for oncology practices. Practices can also use COAnalyzer, COA’s free financial modeling tool, to assess the rule’s impact on their specific service mix, operations, and projections.

Registered COA members and community oncology practices can access the on-demand recording resources at https://mycoa.communityoncology.org/events/webinars/the-2026-medicare-physician-fee-schedule-implications-for-community-oncology

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About the Community Oncology Alliance

The Community Oncology Alliance (COA) is a nonprofit organization dedicated to advocating for community oncology practices and, most importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where the majority of Americans with cancer are treated. The mission of COA is to ensure that patients with cancer receive quality, affordable, and accessible cancer care in their own communities. Learn more about COA at www.communityoncology.org.

Drew Lovejoy
Community Oncology Alliance
info@coacancer.org

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