Targeted therapies are underused in patients with EGFR– or ALK-altered, metastatic non-small cell lung cancer (NSCLC) who are insured by Medicaid, according to research published in JAMA Network Open.

Researchers analyzed data from 33 US states and found that EGFR– and ALK-targeted therapies were underprescribed in all but 3 states. This may have led to an estimated 855 preventable years of life lost, according to the researchers. 

To assess the use of targeted therapies among Medicaid patients with metastatic NSCLC, researchers used data from the Medicaid Drug Utilization Database from 2020 and 2021.

Continue Reading

During the period studied, there were 3461 person-years in which EGFR– or ALK-targeted therapies were indicated. However, 2281 person-years of EGFR– or ALK-targeted therapies were dispensed. This translates to 66% of Medicaid patients with EGFR– and ALK-altered metastatic NSCLC receiving indicated targeted therapies. 

The most commonly dispensed agents were osimertinib, alectinib, crizotinib, and lorlatinib. 

The rates of targeted therapy use varied across states, with the lowest use in Arkansas (18%) and the highest use in Massachusetts (113%). Overall, the rate of targeted therapy use was lower than expected in 30 of the 33 states evaluated. 

“Only 3 states (9%) had dispensing volumes consistent with expected levels, 12 states (36%) had dispensing volumes somewhat below expected levels, and 18 states (55%) had dispensing volumes substantially below expected levels,” the researchers wrote.

The variation in targeted therapy use was influenced by access to state Medicaid programs, the mean number of oncologists per 100,000 Medicaid enrollees, and state gross domestic product per capita. 

“The association between the observed variation and states’ Medicaid access scores suggests that state policies and characteristics are associated with use of these medications,” the researchers wrote. For example, states with low dispensing volumes may provide inadequate coverage for genomic testing or have prior authorization policies that discourage use of targeted agents.

The analysis suggests that “at least 500 Medicaid patients with a diagnosis of EGFR- or ALK-altered metastatic NSCLC during these years did not receive targeted therapy when indicated,” the researchers noted. “Given the efficacy of targeted therapies, this underuse could have led to an estimated 855 preventable years of life lost during the period of analysis.”

Modifying state Medicaid policies to improve access and performing claims-based analysis on individual patient data may help address this health disparity, the researchers concluded.

Disclosures: This research was partly supported by Arnold Ventures. One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Roberts TJ, Kesselheim AS, Avorn J. Variation in use of lung cancer targeted therapies across state Medicaid programs, 2020-2021. JAMA Netw Open. Published online January 25, 2023. doi:10.1001/jamanetworkopen.2022.52562