Most commercial plans cover SC and IV oncology therapies at parity

Across seven oncology therapies, most U.S. commercial plans placed subcutaneous and intravenous formulations at parity, according to a poster at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.

“Variation between health plans may create barriers to consistent patient access to SC formulations,” researchers wrote. “As more SC oncology therapies gain approval, payer coverage policies will play a key role in shaping patient access.

Many intravenous oncology therapies are being reformulated for subcutaneous use, according to a study published in October 2025 in the Journal of Controlled Release. Subcutaneous formulations offer reduced administration time and improved patient convenience. They enable treatment to shift from a hospital setting to an outpatient setting or self-injection at home. found that the clinical development of high-dose biologics is shifting from IV to SC administration.

They also change how insurance companies reimburse for these drugs. IV drugs are reimbursed through the medical benefit, while subcutaneous injections are covered through the pharmacy benefit. Although subcutaneous formulations offer convenience with similar efficacy as IV formulations, they can cost more, according to an abstract presented at the 2025 Annual ASCO meeting.

In this new poster presented at this year’s ASCO, researchers wanted to evaluate whether commercial health plans apply step therapy to oncology drugs that have both a subcutaneous and an intravenous formulation.

The researchers, led by James Chambers, Ph.D., associate professor at the Tufts Medical Center Institute for Clinical Research and Health Policy Studies, used the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) Database to identify U.S. commercial health plans that had coverage policies for oncology drugs available in both subcutaneous and intravenous formulations. The database included coverage criteria from 17 large U.S. commercial health plans.

Researchers assessed seven oncology therapies with both subcutaneous and intravenous formulations covered by at least some plans. These included Rybrevant (amivantamab), Tecentriq (atezolizumab), Darzalex (daratumumab), Opdivo (nivolumab), Keytruda (pembrolizumab), Rituxan (rituximab), and Herceptin (trastuzumab). Both subcutaneous formulations were approved between 3 and 11 years after the intravenous therapies were approved.

Overall, there was a 91% coverage parity for subcutaneous and intravenous formulations among the products studied by researchers. But there was some variation in coverage that researchers said may create barriers for consistent access. IV-preferred coverage ranged from 0% to 14% across the drugs studied. Five payers enforced an IV-preferred policy.

Step therapy was primarily applied to older therapies with biosimilars. (Biosimilar options for IV rituximab and trastuzumab, which became available in 2019 and 2020.) No payers preferred the subcutaneous formulation only.

This study was funded by The National Pharmaceutical Council.