American Journal of Managed Care — Management of high and rising costs in oncology requires a multifaceted approach using both innovative strat­egies and pragmatic tools. Increased spend is often attributed by plan spon­sors to factors including the growing number of novel oncology therapies and expanded indications for previ­ously approved therapies. In this ar­ticle, we discuss these and several ad­ditional factors also influencing costs of oncology care, including improved patient survival, regulatory changes, increasing drug utilization, off-label drug use, and provider consolidation.