Policy Town Hall: Advancing Care Through State-Level Advocacy

On June 25, 2025, multidisciplinary health care professionals, policy strategists, and leaders from state-based oncology societies convened for the second annual Policy Town Hall—a focused, forward-looking forum on state legislative trends shaping cancer care across the United States.

Featuring expert insights from Anna Pugh, president of AGP Strategies, Nick Telesco, state advocacy specialist with the American Society of Clinical Oncology (ASCO), and case studies from the Rocky Mountain Oncology Society, the Montana State Oncology Society, and the Tennessee Oncology Practice Society, this year’s Town Hall spotlighted how state-level action is stepping up in the face of federal policy stagnation. As participants explored emerging challenges, successful advocacy models, and strategic approaches to advancing patient-cen­tered policy and safeguarding access to equitable and affordable care, the discussion centered on what’s working, what’s next, and how oncology health care professionals can continue driving change through their advocacy efforts—state by state.

Federal Legislative Landscape
• Washington DC gridlock. Ongoing political polarization and administrative delays, particularly within agencies like the Centers for Medicare & Medicaid Services (CMS), continue to stall meaningful progress on cancer policy at the federal level.

• A policy gap. The growing disconnect between federal inaction and state-level responsiveness has positioned state legislatures at the front line for addressing urgent patient care issues.

• An advocacy shift. Cancer policy advocates are turning their attention to state legisla­tures, offering states new opportunities for engagement, coalition-building and legislative focus.

• Medicaid under pressure. States are weighing work requirements and re-enroll­ment restrictions that could limit Medicaid access. These proposals risk creating administrative hurdles and coverage gaps, raising concerns for patients and oncology practices alike.


Key Takeaways: State-Level Advocacy
• Momentum at the state level. Bipartisan collaboration on key issues, such as prior authorization reform, pharmacy benefit management (PBM) regulation, and biomarker testing, helped drive meaningful progress in 2025. States like Colorado and Louisiana passed PBM reform bills aimed at curbing cost inflation and improving drug access.

• ASCO’s advocacy footprint. ASCO tracked over 500 bills in 2025, submitted 165 letters to state legislators (95% in partnership with state affiliates), supported 18 bills that became law, and helped defeat 4 bills. Collaboration with state-level coalitions and affiliates helped advance legislation on step therapy, fertility preservation, and Medicaid access.

• Budget realities. With the end of COVID-era funding, federal funding cuts, and growing lists of priority agenda items, many states face significant budget deficits. Advocates emphasized the importance of framing policies around cost-effectiveness and patient impact to gain bipartisan support.

Successful Strategies in 2025
• Amplify patient and physician voices and leverage grassroots tools. Real-world stories and digital platforms are among the most effective tools in legislative advocacy. Patient and clinician testimo­nies can reframe policy, while online tools and early engagement help mobilize stakeholders and maintain visibility throughout the session.

In Action
The Tennessee Oncology Practice Society advanced step therapy reform through a two-pronged strategy: an online advocacy tool that enabled members to email dozens of legislators with one click, and a Day on the Hill where board members shared patient stories directly with lawmakers. This mix of grassroots efforts and personal testimony proved decisive in passing bipartisan legislation limiting step therapy protocols for patients with metastatic cancer.

• Build coalitions. Strategic partnerships with medical societies, patient advocacy groups, and issue-based coalitions help amplify advocacy efforts and share resources across states.

In Action
ASCO’s collaboration with coalitions—such as All Copays Count, the Alliance for Fertility Preservation, and the State Access to Innovative Medicines Coalition—enabled coordinated support for legislation across multiple states. These partnerships helped pass fertility preservation bills in Hawaii, New Mexico, and Washington, and supported step therapy reforms in Montana and Tennessee.

• Engage local lobbyists and legislators. Working with lobbyists and legislators who understand the political landscape and local dynamics is key to navigating complex policy environments.

In Action
In Colorado, House Bill 1094—a PBM reform bill—passed after years of advocacy. The bill, which shifts PBM compensation from percentage-based to flat-rate models, gained bipartisan support, particularly from rural legislators whose constituents faced limited access to affordable medications. Backed by a local lobbyist and strong community support, the bill was signed into law with a fiscal note projected as $0 in the first year and just under $9,000 in subsequent years.

2026 Legislative Priorities
• Strengthening PBM oversight and enforce­ment. While several states passed PBM reform bills in 2025, enforcement remains a challenge. Advocates are now focused on implementation, oversight, and regulatory frameworks to ensure compliance.

• Expanding biomarker testing legislation.
With over a dozen states considering biomarker bills in 2025, there is momentum to expand coverage and remove barriers to testing. Advocates aim to push for broader biomarker legislation in 2026.

• Preserving Medicaid access. Proposed work requirements and re-enrollment rules create paperwork burdens and confusing coverage rules that cause patients—especially rural residents and lower income individuals—to lose benefits. Advocates are engaging early in regulatory comment periods and state budget discussions to prevent restrictions that would limit access and increase uncompensated care.

• Prior authorization implementation.
Although prior authorization reform bills passed in several states, barriers persist due to inconsistent implementation. Advocates plan to focus on regulatory oversight, insurer accountability, and physician reporting.

• Elevating patient voices. More state societies are exploring ways to systematically collect and use patient stories to support testimony, media outreach, and legislative campaigns, making patient voices a central part of advocacy strategy.

Road Ahead
The 2025 Policy Town Hall concluded with a clear call to action: multidisciplinary health care professionals and state society members must remain engaged, proactive, and collaborative in their advocacy efforts. In a time of federal inaction, state societies, clinicians, and patients are leading the charge for smarter policy and stronger protections for people with cancer. With 2026 on the horizon, the oncology community is well-positioned to shape policy and drive meaningful improvements in patient care—one state at a time.

Rania Emara is assistant director of editorial content at the Association of Cancer Care Centers in Rockville, Maryland.

Get Involved
The individual state-based oncology societies often engage in policy work and have local policy committees to help shape policy focus areas, track state-level legislative priorities, and monitor progress during legislative sessions. To learn more about or join your state society policy committee, email Lu Anne Bankert at lbankert@ accc-cancer.org.