The American Cancer Society (ACS) Cancer Action Network has released new policy recommendations to increase the uptake of biomarker testing and to advance the use of precision medicine in cancer care. A recent report by the ACS Cancer Action Network and the LUNGevity Foundation found that although health-insurance coverage for biomarker testing has improved since the organizations’ prior report in 2018, it is still failing to keep up with innovation, and large coverage gaps remain. The review—which focused on breast, colorectal, lung, and prostate cancers—found that coverage is more prominent for single-gene tests and that health-insurance companies are still slow to cover multigene panels.
Additionally, in an ACS Cancer Action Network survey of patients with cancer and cancer survivors, conducted in the spring of 2020, just over one-third of respondents reported having biomarker testing. Of those who reported not receiving biomarker testing, more than one-quarter said it was because insurance would not cover it or that their out-of-pocket costs would be too high.
Although coverage is foundational to accessing biomarkers for determining the best treatment for a specific cancer diagnosis, it is just one of several factors necessary, as highlighted in a new white paper from the ACS Cancer Action Network. According to the report, additional factors include the availability of relevant tests; health-care provider knowledge and awareness of which tests to use and when; and health-care facilities equipped with the appropriate testing infrastructure.
Proposed Innovations
To address these barriers, the ACS Cancer Action Network recommends the following:
- Payers should provide coverage for U.S. Food and Drug Administration–cleared or –approved companion and complementary diagnostics as necessary to evaluate patient eligibility for a given targeted therapy and all National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology–indicated biomarker tests.
- Payers should provide coverage and access to genetic counseling prior to and after the interpretation of biomarker tests.
- Comprehensive biomarker testing provides value beyond therapy selection, and results from testing should be used to inform patients of relevant clinical trial opportunities.
- Biomarker tests should be reliable, valid, and relevant to a patient’s cancer diagnosis. This should be realized with a harmonized system of regulatory oversight for all biomarker tests.
- Providers and institutions should be equipped with tools, resources, and training for the efficient and adequate collection and handling of tissue for testing as well as the proper test selection, administration, and interpretation.
