Targeted therapy use following Medicare's coverage expansion for next-generation sequencing in older adults with lung...

To examine whether Medicare's 2018 National Coverage Determination (NCD) for next-generation sequencing (NGS) was associated with changes in the use of targeted oral anticancer therapies among older adults with lung cancer.

Retrospective cohort study. Multivariable logistic regression was used to estimate the probability of initiating an oral targeted therapy within 12 months of diagnosis. Key exposures were (1) diagnosis before versus after the NCD and (2) residence in a region with versus without pre-NCD NGS. Data were drawn from the SEER-Medicare linked data with Part D claims, including diagnosis years 2016-2019 with follow-up through 2020. The analytic sample included Medicare fee-for-service Part D beneficiaries aged 65 years or older with newly diagnosed lung cancer.

Among 30,855 Medicare fee-for-service Part D beneficiaries with lung cancer, 7.1% used targeted oral anticancer therapies. The NCD was not associated with a significant overall change in targeted therapy use (0.4 Percentage Point; 95% CI, -1.6 to 2.4; p = 0.71). Before NCD implementation, targeted therapy use was 1.0 PP higher in regions with pre-NCD NGS coverage than in regions without such coverage (95% CI, 0.2-1.9; p = 0.015). In stage-stratified analyses, the additional post-NCD change was significant among patients with distant-stage disease (3.2 PPs; 95% CI, 2.6-4.0; p < 0.001) but not among those with regional-stage disease (p = 0.29).

Medicare's NCD for NGS was not associated with a significant overall increase in targeted oral anticancer therapy use but was associated with increased use among patients with distant-stage disease. Targeted therapy use remained higher in regions with preexisting NGS coverage.