The Pathways Guys

Journal of Clinical Pathways is proud to introduce The Pathways Guys podcast, hosted by Gordon Kuntz and Bryan Loy—a new podcast series exploring the real-world impact of clinical pathways on oncology policy, payment, and practice.

In the launch episode, Gordon and Bryan examine:

• Why payers develop and depend on pathway programs
• How pathways align cost management, quality, and innovation
• The connection between clinical pathways, medical policy, and formularies
• What “quality care” truly means from a payer perspective

Why it matters:

• Pharma market access teams: Understand the framework shaping access and coverage decisions
• Oncology practices: Gain insight into the payer perspective on pathway adoption
• MSLs and product leaders: Strengthen stakeholder conversations with payer-informed context
• Pathway developers: Learn how payers evaluate value and make pathway decisions

Prior auths are almost always approved—but they still create delays, costs, and frustration for oncology practices and patients. In this episode, Bryan Loy and Gordon Kuntz unpack why payers rely on prior authorizations, what they’re really trying to learn that claims can’t show, and where the current system breaks down. As Gordon puts it: “If you ask 100 oncologists about prior authorization… 130 to 150 of them would say they hated it.” They also explore what it would take to reduce burden without losing accountability—especially as value-based care expands.

Oncology is moving steadily toward value-based care—but “total cost of care” is one of the most challenging (and misunderstood) concepts in these arrangements. In this episode of The Pathways Guys, host Gordon Kuntz (provider pathways veteran) and Bryan Loy (payer-side leader) unpack what total cost of care really means, why defining boundaries is so difficult, and how attribution can create unintended consequences.

They explore:

• What to include vs. exclude when measuring “total cost of care”
• Concentric rings of accountability (services billed, ordered, referred, and beyond)
• The tension between utilization vs. unit cost—and lack of provider visibility into pricing
• Care fragmentation risks when incentives aren’t aligned
• Why analytics, trust, and better measurement systems matter
• The patient perspective—and the real fear of “remission and bankruptcy” happening at the same time

Listen now, and subscribe for more conversations at the intersection of pathways, payers, and value-based oncology.

FDA approval is just the beginning.

In this episode of The Pathway Guys, Gordon Kuntz and Bryan Loy are joined by Susan Weidner to unpack how payers evaluate new oncology therapies — and what it really takes to move from approval to patient access.

They discuss:

• How clinical trials are designed — and where evidence gaps create real-world uncertainty
• The challenges of accelerated approval and balancing innovation with unanswered questions
• The growing role of real-world evidence, biomarkers, and minimal residual disease (MRD)
• Evaluating therapies in complex diseases like non-small cell lung cancer and multiple myeloma
• What payers want to hear (and don’t want to hear) from pharma

This episode offers practical, behind-the-scenes insight for professionals in oncology, pharma, market access, pathways, and payer strategy who want to better understand how coverage decisions really get made.

They explore key topics including PBM formulary strategy, payer influence, prior authorization, and step therapy, and how these tools shape access to oral oncology drugs and specialty pharmacy treatments. The discussion highlights the growing importance of value-based care, total cost of care, and clinical pathways—and where misalignment between formularies, medical policy, and oncology pathways can create challenges for providers and patients.

Gordon and Bryan also examine real-world issues like drug pricing, rebates, biosimilars, patient affordability, medication adherence, and administrative burden, along with the expanding role of PBMs in both oral and infused cancer therapies.

If you work in oncology, managed care, market access, or pharma strategy, this episode offers essential insights into how Part D coverage decisions are made—and how they ultimately affect patient outcomes.