A manufacturer of a new oncology therapy launched a high-cost therapy where every case required significant reimbursement and clinical expertise. Individual cases were complex, so success depended on coordination across several teams.
PRO’s case management teams submitted each case thoroughly and accurately, and pursued independent medical review on every denial. The team kept the treating facility, the case management team, and the payor continuously aligned, backed by clinical navigation and affordability support for patients.
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CONCLUSION
For CY 2026 to date, the program has achieved a 100% approval rate, with enrollment volume up 107% year over year. All CMS PPS-exempt cancer hospitals are participating in the program, alongside commercial facilities. When every case is submitted thoroughly and every denial receives independent medical review, complex oncology therapies can reach patients with confidence. Learn more about our Patient Support and Hub Services.
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