Survey Reports Widespread Adoption of Bispecifics in Community Oncology

According to results from a national survey recently conducted by the Community Oncology Alliance (COA), bispecific therapy has been widely incorporated into treatment practices at independent community oncology practices, although reimbursement, monitoring requirements, and coordination with local hospitals remain challenges to expanding and sustaining in-office programs.^1,2

The survey, conducted over 4 weeks in June and July 2026, included 104 respondents, 97 of whom identified as working in independent community oncology practices. Respondents included practice administrators and executives, pharmacists and pharmacy leaders, nurses, advanced practice providers, physicians, revenue cycle personnel, and value-based care leaders.

Among 93 respondents who answered whether their practice currently administered bispecific therapy, 91.4% said they did. Another 5.4% said they did not currently administer bispecific therapy but planned to begin within 12 months, while 2.2% said they did not administer bispecific therapy and were not planning to do so. The findings come as bispecific therapies are increasingly used across hematologic and solid tumor settings.

“Community practices are not waiting on the sidelines—they are already delivering bispecific therapies and taking responsibility for ongoing treatment,” Christine Pfaff, RPh, MBA, director of clinical initiatives at Community Oncology Alliance, stated in a news release. “What has not kept pace is the infrastructure surrounding that care. Practices need payment for the monitoring these treatments require and dependable hospital pathways when a patient needs urgent evaluation or admission beyond what can be managed in the practice.”

Maintenance Dosing Predominantly Remains In-Office

Maintenance treatment was much more commonly provided in the community setting. Of 77 respondents, 89.6% reported administering maintenance dosing in their office for all patients, while 10.4% used a combination of hospital and office administration. No respondents reported that all maintenance dosing occurred at an academic medical center or hospital.

Among practices that referred patients for maintenance dosing, 16.9% cited continued high risk for cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS), while 15.6% cited insurance restrictions and 7.8% cited patient comorbidities.

Reimbursement and Hospital Coordination Remain Challenges

Despite widespread adoption, practices reported several barriers to operating bispecific programs. The most frequently cited challenge, reported by 51.3% of 78 respondents, was difficulty coordinating care with local hospitals for potential adverse-event management, including CRS and ICANS. Other barriers included inadequate reimbursement for staff monitoring time (35.9%), the time-intensive nature of patient monitoring (28.2%), physician or advanced practice provider concerns about taking call (25.6%), and staff hesitancy related to adverse-event risk (24.4%).

Extending Support to Practices

When asked what would help build or sustain a bispecific program, respondents most often pointed to reimbursement and tools to reduce monitoring burden. Among 77 respondents, 75.3% selected additional reimbursement codes covering nursing and pharmacy monitoring time, and 75.3% selected clinical tools such as phone applications and patient monitoring devices. Advocacy for fair payer coverage and reimbursement was selected by nearly 60%, while 55.8% cited operational guidance and shared best practices among community practices.

The findings highlight that expanding access to bispecific therapy in the community involves more than the ability to administer the drug itself. Respondents' written comments pointed to additional needs around after-hours monitoring, remote monitoring, standardized operating procedures, patient education, and coordination with local hospitals. Some respondents specifically described the need for stronger hospital partnerships to support management of treatment-related adverse events and for reimbursement models that account for the nursing, pharmacy, and other resources required to monitor patients.

Taken together, the survey demonstrates the substantial capacity of community practices to deliver bispecific therapy while highlighting ongoing needs related to monitoring, staffing, reimbursement, and hospital coordination.As use of these therapies continues to expand in community settings, reimbursement, monitoring resources and tools, standardized processes, and hospital collaboration will be key components to support outpatient delivery.

REFERENCES

1. COA Survey Finds High Bispecific-Therapy Adoption Among Community Oncology Practices. News release. Community Oncology Alliance. September 21, 2026. Accessed September 22, 2026. https://tinyurl.com/yz97y2nf

2. Community Oncology Bispecific Administration Survey Results. Community Oncology Alliance. September 18, 2026. Accessed September 22, 2026. https://tinyurl.com/yts9uayh