Patients with advanced non-small cell lung cancer (NSCLC) who are beneficiaries of Medicaid are less likely than their commercially-insured counterparts to undergo biomarker testing and receive biomarker-directed treatment, a new study suggests. 

The study also showed that Medicaid beneficiaries had a higher risk of death than commercially-insured patients, but the risk of death decreased among Medicaid beneficiaries who underwent biomarker testing. 

These results were published in the Journal of the National Comprehensive Cancer Network.

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The retrospective study included data from 865 patients with Medicaid and 6145 patients with commercial insurance from the Flatiron Health Database. The patients were diagnosed with advanced NSCLC between 2011 and 2019. 

The researchers assessed the use of biomarker testing in the first 3 months after diagnosis. Biomarkers included ALK, EGFR, ROS1, BRAF, and PD-L1. The researchers also assessed the use of biomarker-driven treatment in the first 4 months after diagnosis, as well as the risk of death.

The researchers adjusted for baseline characteristics, including age, sex, race/ethnicity, region, smoking status, histology, year of advanced diagnosis, and site of metastases.

Biomarker testing was less likely to occur in patients on Medicaid than in patients who were commercially insured (hazard ratio [HR], 0.81; 95% CI, 0.74-0.89; P <.001). This was true for any biomarker testing (57% vs 71%) and testing for all individual biomarkers — EGFR (51% vs 65%), ALK (48% vs 63%), ROS1 (29% vs 44), BRAF (22% vs 34%), and PD-L1 (28% vs 37%).

There was a higher risk of death for Medicaid beneficiaries who did not undergo biomarker testing, compared with beneficiaries who had at least 1 biomarker test (HR, 1.27; 95% CI, 1.06-1.52; P =.01). 

Medicaid beneficiaries had a higher risk of death than their commercially-insured peers, regardless of whether biomarker testing was performed. The median overall survival (OS) was 7.8 months and 10.3 months, respectively (HR, 1.23; 95% CI, 1.13-1.35; P <.001).

The researchers suggested this difference could be due, in part, to the fact that Medicaid beneficiaries were less likely to receive any first-line treatment (HR, 0.72; 95% CI, 0.66-0.79; P <.001) as well as being less likely to receive first-line biomarker-directed therapy (HR, 0.70; 95% CI, 0.58-0.85; P <.001).  

“Improved access to evidence-based molecular testing and targeted therapies may improve outcomes for Medicaid beneficiaries with lung cancer,” the researchers concluded.

Disclosures: This study was funded by Genentech, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Gross CP, Meyer CS, Ogale S, Kent M, Wong WB. Associations between Medicaid insurance, biomarker testing, and outcomes in patients with advanced NSCLC. J Natl Compr Canc Netw. 2022;20:479-487.e2. doi:10.6004/jnccn.2021.7083