When my husband and I opened Pontchartrain Cancer Center three days after Hurricane Katrina, we had no furniture, only folding chairs. But we had electricity and clean water, allowing our clinic to quickly become a gathering place for people who had lost nearly everything. Patients arrived hours early, not just for treatment but for air conditioning, a cup of coffee, and the comfort of seeing neighbors who were trying to put the pieces back together. In those weeks, I learned something that I have never forgotten. People facing cancer cling to time, clarity, and trust. They cannot afford uncertainty or delay.
Two decades later, the most destabilizing force many patients face is not a hurricane – it is their insurance company. We’ve seen cancer care advance dramatically, while watching access to that care become more difficult.
President Trump was right to recently call out big insurance companies for rising costs and growing profits, urging the industry to lower prices for Americans. From where I sit in community oncology, that outrage is long overdue, but it only tells part of the story. The same profit-driven incentives fueling higher costs are also embedded in coverage decisions that determine which treatments patients can receive.
Insurers and their pharmacy benefit managers (PBMs) have built a system that works against the very people it is supposed to serve by putting profits over patients. Prior authorizations that were once rare are now routine. Formularies shift constantly. Across cancer care, insurers increasingly impose step therapy, forcing patients to try and demonstrate intolerance to older and often inferior treatments before approving the therapy their physician originally selected.
These barriers are harmful across many areas of health care, but their impact is most severe in cancer, where timing and the right treatment are critical. A delay is not an inconvenience. It is a threat to the patient’s outcome.
I have seen insurers insist on their preferred list of expensive drugs, even a clinically equivalent and less expensive option exists. This often drives up patients’ out-of-pocket costs and makes it harder for them to stay on treatment. These decisions change prognoses. They erode trust. They leave physicians powerless at the very moment our patients need stability and reassurance.
Some of the worst delays happen after a prescription is written. If we can provide medication directly at our clinic, a patient can begin treatment almost immediately. But insurance companies often require the prescription to go through their own specialty pharmacies, which slows everything down. Days turn into weeks. One woman with blood cancer waited more than a month for the drug her doctor had already chosen. That is not an administrative hiccup. It is a dangerous gap in care – and every lost day is time the cancer does not give back.
The Trump administration has begun to acknowledge concerns around insurer practices that delay care. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz have recognized that insurer requirements, including prior authorization, can impede timely treatment and have indicated plans to address these issues. While this represents movement on the issue, for cancer patients any progress must result in measurable improvements in access to care when time is critical.
Congress also has a chance to act. Bipartisan proposals have been reintroduced to rein in abusive practices by PBMs and to place commonsense limits on step therapy. These proposals would finally bring transparency to the middlemen and help ensure that treatment decisions stay where they belong: with physicians and patients. For families across America, this momentum could not be more important.
President Trump’s remarks put a spotlight on a truth patients already know. Big insurance companies have too much power over medical decisions, and this is costing Americans precious time and lives.
Physicians do not go to medical school to let insurers tell them how to practice medicine. We are living in one of the most hopeful periods in cancer care innovation. People are surviving metastatic disease, watching their children grow up and living far beyond what once seemed possible. None of this progress matters if patients cannot access the treatments that gives them hope.
Kathy Oubre is the CEO of Pontchartrain Cancer Center and a longtime advocate for improving access to community-based cancer care in Louisiana.
