Biomarker Testing in Advanced Cancers: State-Level Opportunities

Strategic Insights -

A new study has shed light on the importance of upfront biomarker testing in patients with advanced non-small cell lung cancer (aNSCLC) and metastatic colorectal cancer (mCRC). The research, conducted by Genentech Inc., evaluated the landscape of biomarker testing coverage and reimbursement in state-regulated health plans. The findings suggest that there is an opportunity for state-level legislation to improve testing coverage and access. This could have significant implications for the diagnosis and treatment of these types of cancer.

Key Takeaways:

  • The study evaluated 20,261 patients with aNSCLC (50.3%) or mCRC (49.7%), and found that odds for claims for upfront testing and multigene panel testing (MGPT) were 10% (odds ratio [OR]: 0.90 [0.84-0.97]) and 90% (odds ratio [OR]: 1.15 [1.08-1.23]), respectively.
  • The study concluded that 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.
  • The research was conducted using the IQVIA PharMetrics Plus claims database, and evaluated upfront biomarker testing reimbursements from 2018 to 2022.
  • The study found that among fully insured health plans, there was a significantly lower likelihood of upfront testing (10% vs. 20%, p < 0.001) and MGPT (90% vs. 95%, p < 0.001) compared to self-funded health plans.

Statistics:

  • 20,261 patients with aNSCLC (50.3%) or mCRC (49.7) were included in the study.
  • Odds for claims for upfront testing were 10% (odds ratio [OR]: 0.90 [0.84-0.97]).
  • Odds for claims for multigene panel testing (MGPT) were 90% (odds ratio [OR]: 1.15 [1.08-1.23]).
  • 10% of patients with aNSCLC and 90% of patients with mCRC underwent upfront testing and MGPT, respectively.
  • The study evaluated upfront biomarker testing reimbursements from 2018 to 2022.
  • Fully insured health plans had a lower likelihood of upfront testing (10% vs. 20%, p < 0.001) and MGPT (90% vs. 95%, p < 0.001) compared to self-funded health plans.

Sources:

  • State-level opportunities to advance biomarker testing in patients with advanced cancers and state-regulated plans. Future Oncology, 2025;21(21):2747-2755.
  • Genentech Inc. (2025, September 16). Studies from Genentech Inc. Further Understanding of Biomarkers (State-level opportunities to advance biomarker testing in patients with advanced cancers and state-regulated plans). Cancer Weekly, p 112.