Cancer Biomarker Test Utilization and Reimbursement in Australia: A National Analysis of Medicare Data

Biomarker testing plays a critical role in precision oncology by guiding targeted therapy selection. In Australia, public reimbursement for somatic tumor biomarker tests has expanded over the past decade, yet national data on utilization patterns, equity of access, and public expenditure remain limited. We identified all cancer biomarker tests listed in the March 2025 Medicare Benefits Schedule (MBS), defined as tumor-based assays and selected germline tests used to guide systemic cancer therapy. National claims and expenditure (2010-2024) were extracted from publicly available Medicare Item Statistics. Trends were analyzed by test type, sex, age group, and jurisdiction, and standardized to the 2020 cancer incidence as a proxy for population-level testing coverage. We identified 21 reimbursed cancer biomarker test items, of which 19 had claims during the study period. Between 2010 and 2024, annual claims increased nearly fivefold, from 5130 to 25,374, representing 6% of all MBS-funded genetic test volume and 10% of total expenditure. Median reimbursement per test rose from AU$339 in 2014 to AU$667 in 2024, reflecting increased use of multigene panel tests. Uptake tripled among adults aged 75-84 years, while remaining below 3% among individuals under 35 years. Women accounted for 67% of claims in 2024, down from 88% in 2014. Geographic disparities were marked, with test uptake highest in New South Wales (23.8% of incident cancers) and lowest in the Northern Territory (8.7%). Although national funding for cancer biomarker testing has increased, utilization in Australia remains uneven across demographic and geographic lines. These findings highlight the need to ensure equitable access to genomic diagnostics as part of routine cancer care.