Urology practices’ growing role in oncology: Three trends to watch

By Daniel Blumin

Associate partner at The Dedham Group, a Norstella company

In 2024, urology practices continue to expand their role in the oncology treatment space, and proactive pharma companies are increasingly focusing on this channel. Historically, urology practices directed their patients to specialized oncology practices and academic care centers for treatment of advanced genitourinary (GU) cancers, such as prostate cancer or urothelial carcinoma. However, in recent years, many urology practices have evolved, establishing their own internal capabilities to diagnose and treat cancer patients, increasing their patient retention. This shift of clinical sophistication is occurring in the context of broader urology practice consolidation and increasing “top-down” operational influences which often mirror standardization and purchasing models seen in oncology community practice networks. Pharma companies with pipeline and established products in the GU oncology space are evaluating the impact of the rapidly evolving urology practice channel to ensure long-term access, adoption, and brand performance.

Below, we outline three key trends to watch in the urology practice channel, and how pharma companies may respond:

1. Growing oncology care capabilities and infrastructure: Over the last few years, urology practices have become more comfortable diagnosing patients and prescribing treatments for oncology conditions like bladder cancer and prostate cancer. This is highly practice-specific but generally driven by three main factors. First, advanced practices and urology consortiums have created cancer treatment guidelines for their physicians and built recommendations for urologic oncology drugs into their EMRs. Some urology practices have also expanded staffing of urologic oncology specialists, instead of relying exclusively on referral networks. Additionally, practices are increasingly considering clinical trial participation, increasing awareness of incoming therapy modalities and novel diagnostic approach, such as increasing genetic testing and targeted therapy use in prostate and bladder cancer. Together, these factors result in urology practices which are more likely to treat earlier disease stages and retain more patients until later lines of therapy or more complex cases.

Supporting this oncology care expansion, urology practices are also building their operational capabilities, with their own internal dispensing pharmacies and increased investment in infusion suites, allowing administration for immunotherapies or radiotherapies in certain GU cancer types.

As urology practices continue to expand clinical sophistication and operational capabilities, pharma companies are re-evaluating high-priority urology practices and networks, and dedicating resources to supporting clinical education as practices treat new patient types and adopt increasingly specialized and complex oncology products with specific care management needs, as well as long-term consideration of select practices in clinical trial participation and field reimbursement teams to optimize support in areas where practices have limited prior experience or support staff. Medical teams may need to expand their focus to consider clinical guidelines commonly referenced in this space, such as the AUA. This novel approach involves dedicating more resources to a comprehensive channel strategy, which targets and engages urology practices according to their oncology care acumen and sophistication, and identifying brand- and customer-specific needs.

2. Oncology market evolution: The GU oncology market continues to evolve through approval of new products, expanding arsenals of treatment modalities, and macro-level market trends, which all have the potential to impact prescribing behaviors within the urology practice channel. Drug-driven changes in the market such as the availability of low-cost generic drugs and biosimilars, novel routes of administration for established on-market brands (such as SubQ reformulations of infused regimens), and a diverse pipeline of therapeutic options may influence urologist decision-making in the future. Notable examples in recent years are the FDA approvals of immunotherapy products in earlier stages of bladder cancer (NMIBC), expanding FDA-approved use of oral prostate cancer products into earlier non-metastatic spaces, and increasing relevance of targeted therapy and genetic testing in GU oncology.

Additionally, macro-level market trends such as the potential impacts of the IRA and other federal/state regulatory policy, a growing role for value-based models such as the EOM and payer-driven value-based models, and expanding payer utilization management levers (such as PA restrictions, use of pathways, DIR fees, and white bagging) will continue to impact urology practices alongside their counterparts in oncology practices and cancer centers.

Pharma companies which continually monitor these trends to support their traditional customers in oncology will need to consider expanding their focus to include urology practices as new FDA approvals bring GU oncology care into earlier settings with increased urology practice exposure.

3. Private equity’s growing influence and practice consolidation: As urology practices look for new ways to grow and compete, private equity investment is playing a significant role. Partnering with private equity gives urology practices administrative and staffing support and additional capital to handle a larger volume of patients; and in some cases, supports restructuring of urology groups to make them more efficient. While most private equity groups have limited influence on therapy decision-making and purchasing, certain private equity-backed practices cite a growing influence on practice performance and increased scrutiny on product purchasing contracts, especially in competitive spaces. Additionally, certain private equity-backed urology consortiums are starting to develop approaches for care standardization and decision-making support, which can eventually be applied across large practice networks, mirroring the established use of oncology pathways in many community oncology practices (USON, OneOncology). Balancing expanding care delivery in a specialized oncology space with increasing PE influence is a key focus for leaders of PE-backed practices in 2024.

Pharma companies will need to identify the new ownership models and downstream changes in the channel driven by PE acquisitions, including new organizational structures, performance goals, new organizational decision-makers, group purchasing and contracting, value-based care models, and unification of EMRs and formal treatment preferences such as pathways to address customer needs and identify opportunities for long-term partnerships.

Entering 2024, the urology channel’s growing role in oncology care delivery offers both opportunities and challenges for pharma companies. Across the urology practice channel, the growth of oncology care capabilities, earlier-stage GU oncology market entries, macro-level market access events, and increasing roles of private equity and practice consolidation are driving needs for effective urology practice strategies aligned to brand and portfolio priorities. By creating a proactive and strategic engagement plan for the urology practice channel, pharma companies can successfully navigate these challenges in this evolving space to support their patients and customers.

To learn more about The Dedham Group’s strategic consulting services, contact us.