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 P P P 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. In this study, researchers looked at patients with lung or colorectal cancer with different health insurance plans. The goal was to understand if there were differences in cancer biomarker testing plans depending on whether these could or could not be affected by a U.S. state law increasing health insurance coverage of testing. Biomarker testing allows us to find specific biological markers that can help us to understand what the best treatment option is for an individual patient. The study results showed that patients with health insurance plans that could be impacted by a state law had lower biomarker testing coverage than patients with plans not impacted by a state law. In particular, coverage of biomarker tests was much lower for tests which examine multiple biomarkers at once. The study also found that testing coverage varied across U.S. states. The results of this study suggest that state laws could improve coverage and access to biomarker testing for patients with lung or colorectal cancer.