Aakash Desai, Assistant Professor and Associate Director of Phase 1 and Precision Oncology Program at the UAB O’Neal Comprehensive Cancer Center, shared a post on LinkedIn:
“Now in JAMA Oncology with Nirmal Choradia, Rafeh Naqash! Insurance-related barriers continue to deny or delay NGS testing in NSCLC, undermining optimal patient care despite its clinical utility and guideline inclusion.
Key findings:
- 40% of cases required prior authorization (PA) in 2024
- 22-day average for PA response
- 14-day rule forces teams to wait until after discharge to order tests
How this fits:
NGS testing is a cornerstone of high-quality lung cancer care, yet its clinical utility is constrained by fragmented insurance policies and outdated reimbursement policies. The inpatient bundling system, the Medicare 14-day rule, inconsistent state mandates, and restrictions on liquid biopsy all contribute to delayed or denied access. Moreover, this NCD does not extend to earlier-stage disease, despite approvals for adjuvant targeted therapies.
What’s needed:
Federal harmonization of coverage and CMS policy adjustments may ensure more timely and equitable access to biomarker-driven therapies in NSCLC.”
Title: Insurance Barriers to Next-Generation Sequencing Testing in Lung Cancer—When Policy Delays Care
Authors: Nirmal Choradia, Aakash Desai, Abdul Rafeh Naqash.
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