The Service Line

68.5 percent of U.S. counties, home to 50.8 million people, had no radiation oncology practice site as of 2025, and the counties losing clinics skew rural, poorer and sicker than the ones keeping theirs. A study led by Catherine Yu, MD, with senior author Kunal K. Sindhu, MD of the Icahn School of Medicine at Mount Sinai, published online July 9, 2026 in the International Journal of Radiation Oncology, Biology, Physics, is the first nationwide analysis to track individual radiation oncology treatment sites, not physician groups or health systems, using Centers for Medicare and Medicaid Services (CMS) data from 2018 through 2025 across more than 3,000 locations. The national clinic count held roughly stable over that period, but that stability hides churn: 13.6 percent of counties, 427 of 3,144, saw a net loss of radiation oncology sites, more than 70 percent of them in the Midwest or South, and the counties losing clinics had higher poverty and uninsured rates, lower household incomes and fewer primary care physicians than counties that kept theirs. The study lands as Medicare radiation therapy reimbursement has fallen more than 25 percent over the past decade, according to the American Society for Radiation Oncology (ASTRO), which has spent years pushing Congress to pass the Radiation Oncology Case Rate (ROCR) bundled-payment bill after CMS’s own mandatory Radiation Oncology Model was scrapped. Confidence: High on the study’s findings, peer reviewed against CMS’s own data; Medium on how directly reimbursement decline explains the site losses, since the study documents the pattern rather than isolating a single cause. Sources: Loss of Radiation Therapy Clinics Could Widen Cancer Care Gaps Across the United States, Icahn School of Medicine at Mount Sinai, Structural Vulnerability in the United States Radiation Oncology Delivery System: Predictors and Consequences of Practice Site Disappearance, International Journal of Radiation Oncology, Biology, Physics.

Reimbursement

37 percentage points: that is how far CMS wants to cut what hospitals get paid for 340B-acquired cancer drugs, from ASP plus 6 percent down to ASP minus 33.4 percent, starting January 1, 2027. CMS released its Calendar Year (CY) 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule (CMS-1850-P) July 2, 2026, proposing to pay hospitals Average Sales Price (ASP) minus 33.4 percent for drugs acquired through the 340B Drug Pricing Program, replacing the current default of ASP plus 6 percent, based on CMS’s own hospital acquisition-cost survey data; comments close August 31, 2026. The same rule proposes accelerating repayment of the 7.8 billion dollar 340B “remedy,” the money CMS owes hospitals after the Supreme Court found its 2018-2022 340B cuts unlawful in American Hospital Association v. Becerra, by raising the annual clawback from 0.5 percent to 3 percent of drug payments, finishing recovery by the end of CY2029 instead of 2041. CMS estimates the drug-payment cut alone lowers Medicare spending 4.55 billion dollars and beneficiary costs 1.15 billion dollars in 2027, offset elsewhere in OPPS so the overall rule nets to a proposed 2.4 percent payment increase, about 1.9 percent after the 340B-related adjustments. For oncology specifically, the squeeze lands hardest on hospital-employed and health-system-owned infusion programs that have leaned on 340B drug margin to justify acquiring community practices; if the cut survives to a final rule, it could make independent, non-340B community oncology relatively more attractive again, a reversal of the last decade’s consolidation logic. Confidence: High on the proposed rule’s terms, drawn from CMS’s own fact sheet; Low on whether the final terms survive comment, since 340B payment cuts have been proposed, litigated and reversed before. Sources: Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule, CMS, CMS Proposes Major CY 2027 OPPS/ASC Changes Targeting 340B Payments, Site-Neutral Policy, IPO List Phase-Out, and ASC Expansion, Applied Policy.

Enforcement

1.45 million dollars: that is what a Frederick, Maryland chemotherapy practice and its owner will pay after federal prosecutors said they billed Medicare, Medicaid and the Department of Veterans Affairs for cancer drugs patients either never received or that the practice never bought. The Department of Justice (DOJ), through the U.S. Attorney’s Office for the District of Maryland, announced July 1, 2026 that it had settled a False Claims Act whistleblower lawsuit against Progressive Oncology & Hematology, LLC and its owner and sole treating physician, Mouhamad Bazzi, MD, resolving allegations first raised by two former pharmacy technicians in a 2021 suit. Prosecutors alleged two schemes: billing government payers for chemotherapy drugs the practice actually obtained free through manufacturer charitable patient-assistance programs, and billing for chemotherapy that was prescribed but never administered. The settlement resolves civil allegations only, and the defendants did not admit liability. Any single-provider or small-group infusion practice leaning on manufacturer patient-assistance programs should reconcile its free-drug intake against its billing system now, since that exact gap is what the whistleblowers flagged. Confidence: High, drawn from DOJ’s own release. Source: Maryland Oncology Practice Agrees to Pay More Than $1.4M to Resolve False Claims Act Allegations of Fraudulent Billing, U.S. Department of Justice.

Who’s Buying

260 million dollars: that is what a transplant-diagnostics company is paying to break into cancer testing, betting that a blood test for HPV-driven cancers can do for oncology what donor-organ monitoring did for its balance sheet. CareDx, Inc. completed its acquisition of Naveris, Inc. on July 1, 2026, a deal first announced April 29, 2026 and structured, per deal coverage at announcement, as roughly 160 million dollars upfront with up to 100 million more tied to revenue milestones. Naveris makes NavDx, a blood-based molecular residual disease (MRD) surveillance test for human papillomavirus (HPV)-associated head and neck and anal cancers that CareDx says is the only Medicare-covered assay for that indication, reimbursed at 1,800 dollars per test; Naveris has run more than 130,000 commercial tests and brought in roughly 35 million dollars in 2025 revenue, more than double the prior year. CareDx says the deal extends its addressable market past transplant diagnostics to more than 12 billion dollars across transplant, specialty oncology and cell therapy. For oncology practices doing HPV-associated cancer surveillance, the 1,800 dollar Medicare rate is now a public benchmark for what a payer will cover on a molecular monitoring test in this category. Confidence: High on the deal’s completion and Naveris’s test economics, from CareDx’s own release; Medium on the exact 160 million/100 million payment split, sourced to deal coverage rather than CareDx’s own disclosure. Sources: CareDx Completes Acquisition of Naveris, Extending Leadership into High-Growth Specialty Oncology, CareDx, Inc., CareDx to Acquire Naveris for $160M to Expand into HPV-Driven Cancer MRD Monitoring, HIT Consultant.

Clinical Policy

One injection instead of an hours-long infusion chair: that is the operational bet behind FDA’s approval of the first anticancer drug delivered through an on-body injector. The Food and Drug Administration (FDA) approved isatuximab-irfc (Sarclisa Escena, Sanofi-Aventis U.S., LLC) for subcutaneous injection July 9, 2026, across three multiple myeloma combination regimens: with pomalidomide and dexamethasone for patients who received at least one prior line including lenalidomide and a proteasome inhibitor, with carfilzomib and dexamethasone for relapsed or refractory disease after one to three prior lines, and with bortezomib, lenalidomide and dexamethasone for newly diagnosed, transplant-ineligible patients. The drug can be given through the CirCLIQ on-body delivery system or by manual subcutaneous syringe and infusion set; FDA and Sanofi describe it as the first anticancer treatment administered through an on-body injector and the first myeloma treatment available by both on-body and manual subcutaneous routes in the United States. For infusion suites, the shift from an hours-long intravenous administration to a subcutaneous injection changes chair-time math directly, freeing capacity but also shifting billing away from the per-unit infusion administration codes that IV isatuximab generates toward lower-intensity injection coding; practices with a heavy myeloma mix should model both the throughput gain and the revenue-per-visit change before patients start asking for the switch. Confidence: High on the approval itself, FDA’s own notice; Medium on how quickly community practices actually shift prescribing given established IV routines. Source: FDA Approves Isatuximab-irfc for Subcutaneous Injection for Multiple Myeloma Indications, U.S. Food and Drug Administration.

The Operator Metric

The number to track this week: ASP minus 33.4 percent, the payment rate CMS has proposed for every 340B-acquired oncology drug a hospital outpatient department bills starting January 1, 2027. That is a 37-percentage-point swing from today’s ASP plus 6 percent default, applied across chemotherapy, biologics and supportive-care J-codes alike, and it lands on top of a separate CMS proposal to accelerate 340B “remedy” repayment from 0.5 percent to 3 percent of drug payments a year. Any hospital-employed oncology program, MSO or health system running 340B-covered infusion should model its 2027 drug-margin exposure against this rate now, not after the comment period closes August 31, 2026 or the final rule lands around November 1; the modeling should flag which specific J-codes carry the widest ASP spread today, since those are the lines that lose the most margin first if the rate holds. Confidence: High on the proposed rate itself, CMS’s own fact sheet; Low on whether it survives to the final rule unchanged. Source: Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule, CMS.