Rates of Biomarker Testing Among Medicaid Enrollees: Findings From Five States

Biomarker testing is a cornerstone of precision medicine. In the case of cancer care, biomarker tests of tumor tissue provide critical insights into disease risk, treatment response, and prognosis. Often, the results of such tests can guide clinicians in their selection of therapies, helping improve outcomes.

Despite strong clinical support for biomarker testing, barriers to utilization remain. Some states have begun enacting legislation to expand coverage and access to biomarker testing for individuals in state-regulated insurance plans, including Medicaid.

In order to assess the legislation’s effectiveness, Manatt examined the impact of state biomarker testing coverage laws on rates of testing use among Medicaid enrollees with lung cancer in five early adopting states: Arizona, California, Florida, Illinois, and Texas. The analysis focused on use of biomarker tests for non-small cell lung cancer (NSCLC)-associated biomarkers, which may also be used to support treatment of other conditions beyond NSCLC. The analysis also explored trends in biomarker testing methods and assessed variation in utilization across enrollee demographic and Medicaid coverage characteristics.

• State biomarker laws can improve access: In an analysis of five states, modest increases in NSCLC-related biomarker testing rates among Medicaid enrollees with lung cancer were observed in Arizona, California, and Illinois following enactment of biomarker testing legislation. These increases were notable compared to the national trend, which showed persistent decreases in biomarker testing for Medicaid enrollees with lung cancer during this time period. Additionally, four out of five states saw an increase in next-generation sequencing (NGS)-based tests—which permit an assessment of hundreds of genes simultaneously—among lung cancer patients in the year biomarker testing legislation went into effect.
• Laws alone may not be enough to promote optimal access: Although three out of five states saw increased use of NSCLC-related biomarker tests among lung cancer patients following the enactment of legislation, the growth was modest. Other actions, such as campaigns to increase provider awareness of testing coverage and facilitate ordering of guideline-concordant care, may help further improve access.
• Disparities in testing remain: Rates of testing remain lower for certain groups even after enactment of legislation intended to improve access. In particular, Medicaid enrollees with lung cancer who were aged 65 and older, female, or enrolled in fee-for-service delivery systems were less likely to receive biomarker tests relative to other enrollees with lung cancer.

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