A new state law this month made Texas the 11th state to require health insurance companies to pay for biomarker testing.
Doing so will give cancer patients access to more targeted and effective therapies in precision medicine.
KERA’s Sam Baker talks about all this with Dr. Chris Prakash, director of quality services for Texas Oncology and current president of the Texas Society of Clinical Oncology. Prakash helped in efforts to pass Senate Bill 989.
What exactly is biomarker testing?
Biomarkers are proteins and genes on cancer cells that drive cancerous growth. Checking for these biomarkers can give us important information about a person's cancer.
If a specific gene mutation is discovered, then we can treat that cancer with a targeted therapy that targets that particular mutation. So this is the ultimate form of personalized treatment, especially in cancer.
The old way of treating cancer with toxic chemotherapy, which kills off the good and the bad. Now that time is thankfully gone. Now we can target the cancer cells themselves and spare a person's normal body cells.
Is biomarker testing necessary for every cancer patient?
It is helpful for advanced cancers, for sure. And there's more and more data that early-stage cancers benefit from such testing as well.
So, yes, the more information we can get about a person's cancer and any stage of the disease is very helpful for the clinician as well as the patient.
Is this for all forms of cancer?
More so in solid tumors. Liquid tumors, or leukemia and lymphoma, have their own set of molecular analysis that goes on in deciding what kind of treatment would be best for them. But when we talk about biomarker testing, we usually mean solid tumors.
Texas Oncology in 2022 began an internal policy that requires all late-stage tumors to undergo biomarker testing. Why do this for late-stage tumors?
With early stage, a lot of those patients can be cured with surgical modalities, radiation therapies, chemotherapies, and targeted therapies.
For advanced cancers, we're still lacking in how much we can help these patients. So we really need to focus on that population first and get our data and then move on to the earlier stage of disease as well.
Considering all the positive aspects of biomarker testing and the precision medicine that follows, why did it take a legislative bill to get insurance companies to cover the cost of testing and therapies?
I think it all comes down to cost. Any time a new technology comes on, it's expensive. And the national guidelines for oncology, believe it or not, they lag behind. This is such a rapidly evolving field that things change almost on a weekly basis. Now we can even test blood samples for circulating tumor DNA.
So it is such a rapidly evolving field that the insurance companies and the payers and, frankly, even the doctors, have a hard time keeping up with this.
Even with insurance coverage, when you get into co-pays, it's not going to be inexpensive for the patient.
That's right. But this is the first step - that we mandate that any payer needs to cover it. So far what's been happening is that the doctor wants the testing done, we order it, but it gets denied.
And then you're left with a discussion with the patient. Okay. Can you cover this cost? We really need this information to treat you the best. It's going to help treat the cancer the best way, the least toxic way. And that's sad, frankly, that we're having that discussion. So the cost is not going to be totally zero out of pocket. But I think it's a step in the right direction.
RESOURCES:
Biomarker Testing for Cancer Treatment
American Cancer Society: Biomarker Tests and Cancer Treatment
NIH: Biomarker Tests for Molecularly Targeted Therapies: Key to Unlocking Precision Medicine
