Market Access for VA Lung Cancer Therapies

Bottom Line:

Pharmaceutical manufacturers of lung cancer therapies or adjacent therapies must orient their market access strategy toward the VA's Lung Precision Oncology Program (LPOP) structure.

The Department of Veteran Affairs (VA) maintains a strategic, year-round focus on dramatically improving lung cancer survival rates. Lung cancer is one of the leading causes of cancer mortality within the population served by the VA. Veterans face an elevated risk profile to develop lung cancer compared to the general population primarily due to factors like smoking rates and service-related environmental toxins exposure.

The VA healthcare system offers a wide range of services, starting with a robust screening program for early lung cancer detection. The VA estimates approximately 1 million Veterans are eligible for the annual lung cancer screening through low-dose CT scans.

Leveraging its integrated structure, the VA’s dedication to providing top-tier lung cancer care falls under the Lung Precision Oncology Program (LPOP), which is a crucial System of Excellence within the VA. Understanding the LPOP’s centralized structure is the critical component for any market access strategy. As an enterprise-level program, the LPOP employs a highly efficient hub-and-spoke model of care, which ensures standardized, best-in-class treatment protocols are disseminated throughout the full healthcare system. The central hub sites maintain the highest level of expert knowledge and cutting-edge technology while the spoke sites are located at individual VA Medical Centers (VAMCs) throughout the country for initial diagnosis and ongoing treatment.

The LPOP's System of Excellence designation means its clinical leadership influences decisions in the VA’s centralized formulary decision-making for lung cancer therapies (including targeted therapies, immunotherapies, and diagnostics). Manufacturers must demonstrate quantifiable cost-effectiveness and health economic value relative to the existing standard of care to gain favorable access in this system. With the VA’s focus on early detection and precision oncology, a therapy’s value must be more than just efficacy. The VA highly values real-world evidence that both shows superiority in the early-stage Veteran population and addresses the unique comorbidities and environmental exposure history found in Veterans. Ultimately, the LPOP maintains the clinical control over lung cancer therapeutics across the entire VA system. For pharmaceutical manufacturers, this means any market access strategy must be precision-engineered to engage this specific audience.

VA Focus Area	Key Detail	Market Access Implication
Screening	1M Veterans eligible for annual low-dose CT	Emphasize early-stage interventions
Care Model	Hub-and-spoke (LPOP System of Excellence)	Must align with centralized decision-making
Therapeutics	Formulary driven by LPOP clinical leadership	Demonstrate cost-effectiveness + outcomes
Budget Impact	Requires budget neutrality/value replacement	Strong economic modeling required

The VA’s end-to-end control over Veteran health data enables calculation of the full economic burden associated with poor lung cancer outcomes; however, the VA’s budget structure means manufacturers must demonstrate how a therapy can achieve budget neutrality within the existing pharmacy spend or present an economic value proposition focused on replacing established, less-effective alternatives. Through demonstrating a differentiated, outcomes-based value against the existing standards of care, a manufacturer can align with the VA's foundational goals of early detection, precision oncology, and improved survival for Veterans.