Toolkit empowers employers to design coverage that best meets the needs of employees facing a cancer diagnosis
Biomarker testing, a critical tool in the advancing world of precision cancer treatment, has been a required or recommended companion for most of the cancer drugs introduced since 2017. The tests show how specific biomarkers within a person’s tumor can respond to precisely targeted treatments and can literally mean the difference between life and death for those with cancer. Despite this, insurers often do not provide adequate coverage for biomarker testing, or demand cancer patients jump through time-consuming and burdensome hoops before covering tumor testing.
Following its landmark Employer Toolkit on Best Practices for Prescription Drug Benefit Design, CancerCare today released an Employer Toolkit on Biomarker Testing, to help those involved in benefit design make optimal decisions about covering cancer biomarker testing for their employees. It includes explainers, case studies and actionable tools and recommendations based on evidence-based guidelines from independent, expert organizations.
“Precision medicine in oncology has dramatically changed the way cancer is diagnosed and treated,” explains Patricia J. Goldsmith, CEO of CancerCare. “Employers that don’t adequately cover biomarker testing in their insurance plans create a real risk that their employees will not receive the most effective therapy, and instead receive sub-optimal treatment or even treatment that could cause them harm.”
Biomarker testing can ensure that employees with cancer get the right treatments at the right time while saving money and providing better outcomes. For example, lung cancer is the leading cause of cancer death worldwide and has been extremely difficult to treat. With the help of biomarker testing, targeted treatment and immunotherapy, survival rates have soared. And while 89% of oncologists surveyed in 2021 said biomarker testing improves their ability to make more informed treatment recommendations, other research shows almost a third of patients did not have testing due to lack of insurance coverage or unaffordable out-of-pocket costs.
Biomarker testing is increasingly a healthcare equity issue according to data from recent studies.
“Research shows significant disparities in the rate of biomarker testing between Black and white lung and colorectal cancer patients,” said Goldsmith. “Disparities in testing can lead to disparities in clinical trial participation and hinder access to the most effective treatments. These barriers can be addressed by increasing insurance coverage of biomarker testing as recommended by medical experts.”
CancerCare’s Biomarker Toolkit is designed to help employers understand the role and benefits of cancer biomarker testing, so they can ask their consultants and insurance providers the right questions, avoid coverage provisions that could negatively impact covered employees, and design coverage that best meets the needs of employees facing a cancer diagnosis.
The Toolkit explains the basics of biomarkers, their role in guiding treatment decision-making, the biomarker testing landscape, and the current gaps in biomarker testing coverage. It also includes a video series explaining biomarkers, biomarker testing, and highlighting the real-life stories of cancer patients who have benefitted from biomarker testing.
A second section offers resources for working with benefits consultants and insurers to include guideline-recommended coverage of biomarker testing in health insurance plans. It also features important questions to ask consultants, third-party administrators, or healthcare insurance providers; information to help employers avoid coverage provisions that could negatively impact covered employees; and best practice recommendations.