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Purpose: To increase awareness, outline strategies, and offer clinical guidance on navigating the complexities of treatment planning amid antineoplastic drug shortages., Methods: A multidisciplinary panel of oncologists, ethicists, and patient advocates was assembled to provide rapid clinical guidance to help providers navigate appropriate patient care in cases where rationing or alternative therapies must be considered. The groups of content experts developed general principles for resource allocation during shortages and clinical guidance on alternative therapies for specific disease sites. The recommendations are supported by evidence when available., Results: A total of 44 volunteers with content expertise formed the Advisory Group that developed general guidance on the prioritization of antineoplastic agents in limited supply. Disease site-specific clinical guidance was then produced by subgroups on the basis of members' specialties and expertise. The majority of alternative treatment options were developed in consideration of cisplatin and carboplatin shortages. All guidance is posted on ASCO's website., Recommendations: The prioritization of antineoplastic agents in limited supply should be based on specific goals of the therapy where evidence-based medicine has shown survival outcome and life-extending benefit in both early and advanced stages. Recommendations for specific disease sites are presented. While management options vary according to the disease site, alternatives are presented. For settings in which there are no alternatives with comparable efficacy and safety, it is recommended that patients are referred to an area where the necessary drug is available or can be obtained.Additional information is available at asco.org/drug-shortages.

Purpose: CMS' Oncology Care Model (OCM) is an episode-based alternative payment model designed to incent high-value care through the use of monthly payments for enhanced services and performance-based payments on the basis of decreases in spending compared with risk-adjusted historical benchmarks. Transitioning from a fee-for-service model to a value-based, alternative payment model in oncology can be difficult; some practices will perform better than others. We present detailed experiences of four successful OCM practices, each operating under diverse business models and in different geographic areas., Methods: Practices that achieved success in OCM, on the basis of financial metrics, describe pathways to success. The practices represent distinct business models: a medium-sized community oncology practice, a large statewide community oncology practice, a hospital-affiliated practice, and a large academic medical center., Results: Practices describe effective changes in practice culture such as new administrative flexibilities, physician champions, improved communication, changes in physician compensation, and increased physician-level transparency. New or improved clinical services include acute care clinics, care coordination, phone triage, end-of-life care programs, and adoption of treatment pathways that identify high-value drug use, including better use of supportive care drugs., Conclusion: There is no one thing that will ensure success in OCM. Success requires whole practice transformation, encompassing both administrative and clinical changes. Communication between administrative and clinical teams is vital, along with improved data sharing and transparency. Clinical support services must expand to manage problems and symptoms in a timely way to prevent costly emergency department visits and hospitalizations, while constant attention must be paid to making high-value therapeutic choices in both oncolytic and supportive drug categories., Competing Interests: Ronald M. KlineStock and Other Ownership Interests: Las Vegas CyberKnife LLCOther Relationship: CMS, US Office of Personnel Management Sibel BlauEmployment: Northwest Medical SpecialtiesLeadership: Northwest Medical Specialties, Quality Cancer Care AllianceStock and Other Ownership Interests: Northwest Medical Specialties, All4cureHonoraria: Cardinal Health, Novartis, Puma Biotechnology, American Journal of Managed CareResearch Funding: Northwest Medical SpecialtiesExpert Testimony: Northwest Medical SpecialtiesTravel, Accommodations, Expenses: Northwest Medical Specialties, Quality Cancer Care AllianceOther Relationship: Northwest Medical Specialties, All4Cure, Quality Cancer Care Alliance Nikolas R. BuescherStock and Other Ownership Interests: Pfizer Amy R. EllisEmployment: Northwest Medical SpecialtiesLeadership: Northwest Medical SpecialtiesConsulting or Advisory Role: Cardinal Health J. Russell HovermanEmployment: US Oncology Network Lalan S. WilfongEmployment: McKessonSpeakers' Bureau: Pfizer, NCCNTravel, Accommodations, Expenses: E.R. Squibb Sons LLC Gabrielle B. RocqueConsulting or Advisory Role: Pfizer, Flatiron HealthResearch Funding: Carevive Systems, Genentech, PfizerTravel, Accommodations, Expenses: CareviveNo other potential conflicts of interest were reported.