Ways Providers, Payers Can Ensure Biomarker Testing Is Done in Cancer Care

With new technology and improved capabilities of artificial intelligence (AI), providers have more tools at their disposal to improve clinical decision support when a diagnosis is made, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

This transcript has been lightly edited for clarity.

Transcript

What can payers and practices do better to close the gap and ensure biomarker testing is done more often, and that the results are utilized effectively in treatment selection?

Let's start with the providers side, because they're at the beginning with the patient in that journey. So, you've got a diagnosis and now you're going to do a biopsy. I think the providers have a lot of electronic tools at their disposal today that we didn't have even 5 or 10 years ago. We've always had electronic medical records [EMRs] but now they're building out capabilities with AI and the technology’s advancing. We can provide clinical decision support right in the electronic medical record to the ordering party. We can also do internal education, so bringing people maybe out of that EMR and into a clinical pathways guideline that the institution is using or is borrowed from a national guideline. These are important things that you can do at the provider’s side.

The other thing is, if you're in a smaller provider setting, say private practice, then you've got the option to participate with a tumor board. A molecular tumor board is made up of multidisciplinary partners, including medical oncology, laboratory expertise, and patient advocacy. We also have our pharmacists there and some of our other allied health professionals to help make a case decision and recommend a therapy for a patient given all the inputs that they have. And that can really result in a better outcome for that patient in their case. But also, expertise is built in all the members that participate on that tumor board and in that community practice that is partnering with them.

On the payer’s side, I think we can take actions such as changing our prior authorization policies to look for testing results when we make the approval decision—the determination for approval or denial. That's a pretty easy step, but it involves having expertise within the PBM [pharmacy benefit manager] or the third-party administrator who has the depth of knowledge in this field and can look not just at the FDA-approved test that appears in the labeling, but actually looking at the class and saying, “We need this testing for all of our non–small cell lung cancer patients, not just for those on this drug with this biomarker.”

When biomarker testing isn’t done, how does this negatively impact patients and payers alike?

There's strong evidence to show that outcomes are superior when precision medicine is used in the cancers where it brings value. And this can be as impactful as adding up to a year of overall survival to a patient’s life. Just think about that: that's an extra year that they get to spend with their family and their family gets to have that legacy and really to think about all the things they want to say and do. That's really important to patients.

The other thing that's impacted is they're time to next treatment. So, this is also in the same study done in non–small cell lung cancer patients in 2024, and it was published in 2024, and that outcome reduced the time to the next treatment from about 13 months down to 6-and-a-half months. So, another big impactful difference.