Abstract B082: Precision medicine guided by next-generation sequencing: Slow recognition of emerging technologies leads to crucial coverage gaps in health insurance
Authors: Rollyson Phoebe A. , Abshire Camille , Greer Adam , Friday Ellen , Chaudoir Catherine , Mills Glenn 
Published: August 2020

Abstract
While the medical/research community has made great strides in the fight against cancer, providing new and innovative methods and technologies that improve the diagnosis and treatment of the disease, health insurers are slow to recognize the significance of these developments. Numerous biomarkers have been identified for various types of cancers and a variety of therapies have been developed to target these specific genetic abnormalities. However, just as the various types of cancers have varying biomarkers, each patient's tumor bears its own specific genetic signature, causing each patient to respond to prescribed therapies in a different way. Next-generation sequencing (NGS) of a large test panel allows physicians a much broader knowledge of tumor-specific mutations in order to provide the best possible therapy tailored to the patient's specific needs. This individualized treatment is the patient's best hope for managing and defeating the disease. NGS identifies genetic abnormalities present in the patient's tumor. Testing a wider range of genes provides a more specific genetic profile of the patient's tumor, offering a broader range of treatment options and predictive indicators of a patient's response to therapy. The Feist Weiller Cancer Center Genomics Core sequences solid tumor tissue using a 435-gene panel. We provide a comprehensive report identifying genetic variants that are currently targeted by FDA-approved therapies. For each actionable variant, the report lists targeted therapies currently in use for the patient's disease and for other cancers, therapies associated with resistance when the variant is present, and new therapies in clinical trial for the patient's disease. Our panel sequences whole coding regions and is able to detect less common variants in therapy-targeted pathways, dramatically increasing the chance of matching the patient to available treatment. Our panel also measures microsatellite instability and mutation burden, identifying patients as candidates for immuno-oncology therapy. At the Cancer Center, we have tested approximately 200 patients using this panel. In the state of Louisiana, our payer breakdown consists of 44% Medicare, 31% state Medicaid, and 20% private insurance. The federally funded Medicare program recognizes the benefits of genetic testing in cancer treatment and reimburses for the test. However, many private insurers consider broad panel testing to be investigational and many providers of state Medicaid deny coverage of numerous Current Procedural Terminology (CPT) codes covering molecular diagnostic testing. This coverage gap leaves a large portion of our state's population without the necessary access to crucial information needed to make an informed decision concerning cancer treatment.
Citation Format: Phoebe A. Rollyson, Camille Abshire, Adam Greer, Ellen Friday, Catherine Chaudoir, Glenn Mills. Precision medicine guided by next-generation sequencing: Slow recognition of emerging technologies leads to crucial coverage gaps in health insurance [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B082.