State-level opportunities to advance biomarker testing in patients with advanced cancers and state-regulated plans

This study evaluated the landscape and opportunities for improved testing coverage/reimbursement in state-regulated health plans.

Upfront biomarker testing reimbursements (multigene panel testing [MGPT]/single gene testing/no testing; ≤ 90 days after advanced non-small cell lung cancer [aNSCLC] or metastatic colorectal cancer [mCRC] diagnosis) from the IQVIA PharMetrics Plus claims database were assessed by health plan (fully insured, self-funded) and state (2018-2022; via adjusted generalized linear models; bivariate state comparisons via χ² tests).

Among 20,261 patients with aNSCLC (50.3%) or mCRC (49.7%), odds for claims for upfront testing and MGPT, respectively, were 10% (odds ratio [OR]: 0.90 [0.84-0.97], P < 0.01) and 44% lower (OR: 0.56 [0.51-0.62], P < 0.01) for fully insured versus self-funded plans. MGPT claims were identified for < 5% of patients in 13 states and < 10% in 41. Compared with self-funded plans, significantly lower proportions of patients with fully insured plans had upfront testing claims in 6 states (P < 0.05) and MGPT in 10 (differences: 5.7-14.3%, P < 0.05).

Lower upfront testing and MGPT reimbursement among fully insured versus self-funded health plans suggests an opportunity for state-level legislation to improve testing coverage and access.