Only a small percentage of cancer patients covered by Medicare get genomic testing to help guide their treatment, despite a 2018 increase in coverage allowing next generation sequencing testing for this purpose around the U.S.
As reported in JAMA Network Open, the adoption of genomic testing in Medicare beneficiaries with cancer has increased from an average of 6.0% in 2016 to 16.7% in 2023. While this is a significant increase, the overall levels of testing are low despite increased coverage.
“In 2018, Medicare issued a national coverage determination that established consistent nationwide coverage for next generation sequencing testing for eligible patients with advanced cancer,” lead author So-Yeon Kang, PhD, told Inside Precision Medicine.
“It was Medicare’s first and only national coverage determination specifically for genomic testing in cancer. Our study found that genomic testing increased after the policy, but overall uptake remained relatively low, suggesting that insurance coverage alone is not enough to ensure broad adoption of precision medicine.”
For the purposes of this study, the team analyzed insurance claims from over 391,000 Medicare patients aged 66 and older, diagnosed with lung, breast, colorectal, prostate, or endometrial cancer between 2016 and 2023. They tracked whether patients received any genomic testing including older, simpler tests and next-generation sequencing, within six months of diagnosis, and how this changed after the Medicare coverage increased in 2018.
Overall genomic testing nearly tripled, but next-generation sequencing itself grew only modestly, reaching about 2% by 2023. “One possible explanation is that genomic testing has historically been recommended and covered primarily for patients with advanced or metastatic cancer, limiting its use in earlier-stage disease. However, even within the Medicare population, where national coverage for genomic testing exists, the overall uptake remained quite low,” says Kang.
When the researchers looked at testing in each type of cancer, lung cancer patients had by far the biggest shift toward next-generation sequencing, reflecting strong guidelines and many treatable mutations in that cancer. Breast cancer genomic testing rates rose sharply too, but mostly through older-style tests. Those with colorectal or endometrial cancer showed a moderate increase in testing, whereas beneficiaries with prostate cancer had the lowest uptake for any genomic testing.
“The differences likely reflect a combination of factors, including how strongly genomic testing is recommended in clinical guidelines, the availability of targeted therapies for each cancer, and differences in clinical practice,” explains Kang.
Notably, the researchers found no major differences in testing rates by race, ethnicity, or sex, unlike some earlier studies.
As more FDA-approved cancer drugs require genomic test results before they can be prescribed, broadening access to this testing becomes increasingly critical, and demand is expected to grow further as evidence supporting next-generation sequencing accumulates.
“Genomic testing provides the foundational evidence that guides treatment selection throughout the continuum of cancer care. Its role has become increasingly critical with the rapid expansion of precision medicine,” says Kang. “Without genomic testing, patients may receive inappropriate treatment, resulting in the underuse or overuse of targeted therapies and potential safety risks.”
The results suggest coverage alone isn’t enough to close gaps in access to precision cancer care, and that older adults may be missing out on treatments better suited to their tumors’ genetic profiles.
“Our next goal is to better understand the barriers to genomic testing and identify ways to improve access to precision medicine,” says Kang.
