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With the federal landscape continuing to shift, state policy has increasingly become an important arena for legislative change. On average, bills introduced in state legislatures are nearly five times more likely to become law than those introduced in Congress. For practices looking to drive change, they must engage at both the federal and state levels. State advocacy works because relationships are local. Lawmakers respond to the physicians, pharmacists, administrators, and practice leaders who serve their communities and care for their constituents. Policy staff can support, coordinate, and guide the work, but durable progress happens when members are trained, confident, and empowered to speak for themselves. In 2021, the Community Oncology Alliance (COA) set out to build a dedicated state policy program. Federal action to address the cost and accessibility of cancer care was stalling, while interest in state policy was growing among our members. Independent practices were facing growing pressure from pharmacy benefit managers (PBMs), prior authorization requirements, and spread pricing models, and they were asking for support navigating those challenges. COA responded by building a policy program designed to empower practices to drive change in their states. The goal was not simply tracking legislation or publishing updates but to equip practices with the tools needed to advocate for themselves. That meant a focus on training and direct support that would allow members to engage lawmakers confidently and effectively in their own states. To support our initial programming and direction, we focused on establishing state policy retreats, known as the Legislative Leadership Program (LLP), as entry points for next-generation oncology leaders interested in engaging in the policy arena. Through this initiative, we learned more about practice needs, commonalities among states, and reoccurring themes or problems. To date, nearly 200 leaders have gone through this program and are now actively engaged in policy work in their states. COA's state policy team regularly complements the work of these leaders through statehouse visits, arranging meetings with lawmakers, and coordinating engagement at national forums like the National Conference of State Legislatures. After completing the LLP, members have introduced policy ideas, advanced legislation, and built durable relationships that extend well beyond a single bill or legislative session. If you are part of a community oncology practice, your voice makes an enormous difference in the halls where state policy is made. In 2026, it is no longer enough to provide world-class care to serve your patients. You need to make your voice heard so that cancer care remains accessible and affordable for those who need it. If you are new to the world of state policy or are searching for a network of like-minded professionals who are dedicated to protecting community oncology, reach out to COA and join a growing body of passionate advocates.