{"title":"推进晚期癌症患者生物标志物检测的国家级机会和国家监管计划。","authors":"William B Wong, Tu My To","doi":"10.1080/14796694.2025.2542114","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the landscape and opportunities for improved testing coverage/reimbursement in state-regulated health plans.</p><p><strong>Materials & methods: </strong>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 χ<sup>2</sup> tests).</p><p><strong>Results: </strong>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], <i>P</i> < 0.01) and 44% lower (OR: 0.56 [0.51-0.62], <i>P</i> < 0.01) for fully insured versus self-funded plans. MGPT claims were identified for < 5% of patients in 13 states and < 10% in 41. Compared with self-funded plans, significantly lower proportions of patients with fully insured plans had upfront testing claims in 6 states (<i>P</i> < 0.05) and MGPT in 10 (differences: 5.7-14.3%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12672,"journal":{"name":"Future oncology","volume":" ","pages":"2747-2755"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407994/pdf/","citationCount":"0","resultStr":"{\"title\":\"State-level opportunities to advance biomarker testing in patients with advanced cancers and state-regulated plans.\",\"authors\":\"William B Wong, Tu My To\",\"doi\":\"10.1080/14796694.2025.2542114\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This study evaluated the landscape and opportunities for improved testing coverage/reimbursement in state-regulated health plans.</p><p><strong>Materials & methods: </strong>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 χ<sup>2</sup> tests).</p><p><strong>Results: </strong>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], <i>P</i> < 0.01) and 44% lower (OR: 0.56 [0.51-0.62], <i>P</i> < 0.01) for fully insured versus self-funded plans. MGPT claims were identified for < 5% of patients in 13 states and < 10% in 41. Compared with self-funded plans, significantly lower proportions of patients with fully insured plans had upfront testing claims in 6 states (<i>P</i> < 0.05) and MGPT in 10 (differences: 5.7-14.3%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":12672,\"journal\":{\"name\":\"Future oncology\",\"volume\":\" \",\"pages\":\"2747-2755\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407994/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Future oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/14796694.2025.2542114\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Future oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/14796694.2025.2542114","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/5 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
引言：本研究评估了在国家监管的健康计划中改善测试覆盖/报销的前景和机会。材料和方法：前期生物标志物检测报销(多基因面板检测[MGPT]/单基因检测/不检测；从IQVIA PharMetrics Plus索赔数据库中对晚期非小细胞肺癌（aNSCLC）或转移性结直肠癌（mCRC）诊断后≤90天进行健康计划（全额保险，自筹资金）和州(2018-2022；通过调整广义线性模型；通过χ2检验进行双变量状态比较)。结果：在20261例aNSCLC（50.3%）或mCRC（49.7%）患者中，要求进行前期检测和MGPT的赔率分别为10%(比值比[or]: 0.90 [0.84-0.97]， P P P P P结论：与自费医疗计划相比，全额保险计划中较低的前期检测和MGPT报销表明有机会通过州一级立法来提高检测覆盖率和可及性。
State-level opportunities to advance biomarker testing in patients with advanced cancers and state-regulated plans.
Introduction: This study evaluated the landscape and opportunities for improved testing coverage/reimbursement in state-regulated health plans.
Materials & methods: 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).
Results: 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 < 0.01) and 44% lower (OR: 0.56 [0.51-0.62], P < 0.01) for fully insured versus self-funded plans. MGPT claims were identified for < 5% of patients in 13 states and < 10% in 41. Compared with self-funded plans, significantly lower proportions of patients with fully insured plans had upfront testing claims in 6 states (P < 0.05) and MGPT in 10 (differences: 5.7-14.3%, P < 0.05).
Conclusion: 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.
期刊介绍：
Future Oncology (ISSN 1479-6694) provides a forum for a new era of cancer care. The journal focuses on the most important advances and highlights their relevance in the clinical setting. Furthermore, Future Oncology delivers essential information in concise, at-a-glance article formats - vital in delivering information to an increasingly time-constrained community.
The journal takes a forward-looking stance toward the scientific and clinical issues, together with the economic and policy issues that confront us in this new era of cancer care. The journal includes literature awareness such as the latest developments in radiotherapy and immunotherapy, concise commentary and analysis, and full review articles all of which provide key findings, translational to the clinical setting.
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