Oncology economics live in the drug. Fulcrum Health Partners advises practices, oncology CFOs, and PE-backed platforms across buy-and-bill margin, ASP+ methodology, medical-versus-pharmacy benefit strategy, white/brown bagging, pathways, and 340B — turning the most complex reimbursement in medicine into durable enterprise value.
In oncology, the drug is the business — and the spread that funds the practice is razor-thin.
Medicare pays physician-administered drugs at ASP + 6% — roughly 4.3% after the sequester — while a two-quarter ASP lag can leave practices "underwater," reimbursed below their acquisition cost when prices rise. Every dollar of buy-and-bill margin is under pressure.
Payers are pushing drugs from the medical benefit to the pharmacy benefit, mandating white and brown bagging, steering infusion by site of care, and tightening pathways and prior authorization. Layered over 340B dynamics and value-based models like the EOM, the result is the most complex reimbursement environment in healthcare — and precisely where Fulcrum works.
Figures reflect current CMS/MedPAC methodology and industry sources, 2024–2026.
The entire practice runs on the thin brass band. Bagging mandates, benefit shifts, and ASP lag all threaten it.
Fulcrum turns your claims and drug data into executive dashboards. Select an oncology profile to explore a sample payer-mix and drug-margin view.
Illustrative sample dashboard. Fulcrum builds these from your practice-management, dispensing, and claims data by J-code and regimen.
Not a service menu — the drug and service reimbursement problems that decide oncology profitability, and the strategy, analytics, and negotiation capabilities that resolve them.
The spread that funds the practice is thin and eroding. We optimize ASP+ capture, identify underwater drugs, and defend buy-and-bill economics across every payer and regimen.
Benefit shifts and white/brown bagging mandates strip margin and disrupt care. We build the strategy and payer response to protect it.
Commercial oncology hinges on AWP/WAC-based drug terms and administration rates. We negotiate both — with the data to back it.
Drug- and regimen-level modeling that shows exactly where margin is made and lost, by payer and J-code.
We ensure contractual and drug-payment entitlement becomes realized revenue — surfacing underpayments and leakage.
For PE-backed and multisite platforms, we bring institutional-grade reimbursement to diligence, integration, and expansion.
Beyond the fee schedule, these are the dynamics that decide oncology margin — and where Fulcrum builds the strategy.
Defending medical-benefit buy-and-bill as payers push drugs to the PBM-controlled pharmacy benefit.
Responding to bagging mandates that eliminate buy-and-bill margin and raise safety and workflow risk.
Payer programs steering infusion by site of care — and the medical-benefit drug-management vendors enforcing them.
Navigating pathway programs and utilization management that constrain regimen choice and add burden.
Understanding the 340B advantage for hospitals and its competitive pressure on independent practices.
Positioning for the Enhancing Oncology Model and value-based arrangements running through 2030.
Model the annual margin recovery from moving your net drug reimbursement toward its optimized level across Medicare and commercial payers.
Enter approximate figures — nothing is stored or transmitted.
Directional estimate for discussion only; Medicare Part B margin is capped at statutory ASP+6%. Commercial optimization varies by contract. A Fulcrum analysis models your actual drug book and payer terms.
Independent by design and fluent in buy-and-bill — ASP+, AWP/WAC, benefit design, bagging, pathways, and 340B — delivered by the people who do the work.
No networks, no downstream fees — only your economics.
Deep fluency in the economics that fund the practice.
Medical-vs-pharmacy strategy and bagging defense.
Margin modeling down to the J-code and regimen.
Insight into payer drug policy in every market.
Platform-grade reimbursement from diligence to exit.
Quantified analysis behind every recommendation.
Dashboards and intelligence that clarify the path.
Anonymized outcomes from Fulcrum engagements with hematology & oncology practices and platforms.
Identified underwater drugs and ASP+ capture gaps across the regimen book — recovered and protected going forward.
Built the payer strategy and clinical case that reversed a white-bagging mandate — preserving margin and continuity of care.
Improved commercial drug and administration reimbursement across a multi-state oncology platform.
Executive briefings on the forces moving oncology economics — buy-and-bill margin, benefit design, bagging, pathways, and 340B.
Whether you're defending buy-and-bill margin, responding to a bagging mandate, negotiating commercial drug and administration rates, or building a platform, Fulcrum Health Partners delivers the reimbursement expertise oncology leaders rely on.