What’s driving oncology drug spend?
August 26, 2025To better manage oncology drug spending, first consider the factors pushing it ever higher.
Health plans know that oncology costs are rising fast, but a recent IQVIA report put numbers to it: Cancer drug spending increased nearly 16% in 2024.
What’s driving the increase? While new cancer diagnoses in the U.S. passed the 2 million mark last year, the costs aren’t necessarily due to growing prevalence, as the total number of doses of anticancer regimens has held steady over the past five years. Rather, it’s the rising cost of the average dose, with expensive targeted drugs increasingly taking the place of inexpensive chemotherapy.
Even as cancer regimens increase in costs, there are ways to bend the curve while ensuring members receive high-quality care. Here are several of the key factors that Evolent sees pushing the trend, plus interventions we’re using to mitigate their impact.
A host of factors have come together to drive up the cost of the average regimen. The sky-high costs of novel therapies is one.
The cost of newly approved novel therapies reached a median of $442,000 in 2024, up nearly $140,000 from the year before. While such regimens are often for narrow indications and “orphan” diseases, more patients become eligible for them with each year.
In addition to new drugs, we have seen an increase in complex cancer regimens. Rather than replacing existing regimens, a growing portion of new approvals are for combinations of two or more drugs. In fact, 29% of new cancer drug approvals in recent years have been for “add-ons” to existing regimens.
The hope is that synergies between different drugs will offer better outcomes. Yet, combining drugs can increase costs by hundreds of thousands of dollars per year, and these therapies overall have had mixed results. One study found that, while multidrug regimens had higher average response rates than single-drug therapy, there was no significant survival benefit.
Finally, the novel therapies of previous years have gained approval for additional cancer types through indication expansions. For example, the percentage of patients with cancer who are eligible for immune checkpoint inhibitors has increased from 1.5% in 2011 to 55.5% in 2023. Yet, just one in five patients responds to such treatments.
Intervention: Low-value regimen program
Evolent closely follows the evolving evidence around all new and established regimens to identify those that qualify as low-value. Such drugs are typically very high cost relative to other options but do not offer better outcomes. We then work with providers to discourage the use of those regimens and help them instead select treatments identified as high-value in our clinical pathways.
As many forms of cancer become a chronic disease, patients are staying on maintenance regimens for longer periods. For example, with the advent of immune checkpoint inhibitors, the average overall survival in non-small cell lung cancer (NSCLC) has increased from six months to two years, leading to longer durations of therapy.
However, NSCLC patients with no disease progression who continued ICIs beyond two years had no better survival than those who discontinued ICIs. Given that just one in five patients discontinue ICIs at that point, there is a largely untapped opportunity to avoid these drugs, and their potential toxicities, without compromising outcomes.
Intervention: Testing for drug response
Evolent engages with providers and works with them to encourage limiting duration of therapy based to recommended lengths. In addition, our decision-support platform prompts providers to order regular testing to confirm that the patient is continuing to respond to treatment. If they are not responding, that treatment should typically be discontinued.
Today, patients with advanced disease have more options for multiple lines of therapy. In fact, 42% of FDA cancer approvals between 2016 and 2021 were for treatments beyond the first line. Yet, in some cases it’s questionable whether the potential benefits of another medication outweigh the clinical, financial and time toxicities associated with such treatment.
For example, patients with decreased muscle mass (cachexia) or failure to thrive are less likely to respond to treatment. And those with compromised immune systems often do not benefit from immunotherapies.
Intervention: Prospective patient selection
Evolent discourages third-line and beyond therapy for many tumor types and for patients who are highly unlikely to benefit from a regimen, based on their biomarkers and/or clinical factors.
Patient selection is a key tactic that spans all these factors. One regimen may be high-value on a population level, even if it’s costly, but it may be very low value for a given patient. New resources, such as machine learning tools that enable us to predict the likelihood of a response to immune checkpoint inhibitors, can help providers and patients make more informed decisions about whether to go forward with costly therapy.