Biomarker Testing in Oncology
Biomarker testing identifies genetic mutations in a patient's tumor that predict response to specific cancer drugs. For example, EGFR mutations in lung cancer predict response to EGFR inhibitors (erlotinib, osimertinib); HER2 amplification in breast cancer predicts response to trastuzumab (Herceptin); and BRAF mutations in melanoma predict response to BRAF inhibitors (vemurafenib). Without biomarker testing, patients may receive ineffective treatments.
Comprehensive Genomic Profiling
Comprehensive genomic profiling (CGP) tests for hundreds of genetic mutations simultaneously using next-generation sequencing. CGP provides a complete picture of the tumor's genetic profile, identifying all actionable mutations and potential clinical trial eligibility. CGP is increasingly the standard of care for advanced cancers — and is covered by Medicare for certain indications.
Coverage Strategy
IQ Insight
Covering biomarker testing and targeted therapies is both clinically and financially sound. A patient who receives the right targeted therapy based on biomarker testing has better outcomes and may avoid ineffective chemotherapy — reducing total treatment costs. Covering CGP for advanced cancers is a high-value benefit that improves outcomes and demonstrates the plan's commitment to evidence-based care.