Despite Medicare coverage, many cancer patients still do not receive testing that guides treatment options

WASHINGTON — While there has been a recent increase among Medicare recipients in genomic testing that helps match cancer patients to the most effective treatment for their tumor, many Medicare beneficiaries with cancer are still not receiving next-generation sequencing (NGS), according to a new analysis by Georgetown University researchers.

The study appeared in JAMA Network Open on July 29, 2026. (“Genomic Testing Update Among Medicare Beneficiaries with Cancer”)

“Genomic testing is essential for matching cancer patients to the most effective targeted therapies,” says the study’s lead author So‑Yeon Kang, PhD, MBA, MPH, assistant professor of Health Management and Policy at Georgetown University’s School of Health. “While genomic testing became much more common among Medicare beneficiaries between 2016 and 2023, uptake of advanced next-generation sequencing genomic testing remained relatively low, suggesting that many patients may still not be benefiting from precision medicine.”

Medicare’s expanded coverage for NGS testing in 2018 for non-inherited tumor (somatic) mutations and the addition of coverage for inherited (germline) mutations in 2020, marking critical milestones in expanding access to genomic testing.

Before Medicare’s expanded coverage for NGS, coverage for genomic testing was limited and inconsistent. Earlier genomic testing often examined only one or a few genes at a time, whereas NGS testing can analyze many cancer-related genes simultaneously in a single test, helping physicians identify targeted treatment options more efficiently.

Using data from the Medicare Chronic Conditions Data Warehouse, the researchers examined the claims of nearly 400,000 beneficiaries age 66 and older diagnosed with lung, breast, colorectal, prostate or endometrial cancer filed from 2016 through 2023. The analysis tracked the use of both NGS and non‑NGS genomic testing before and after the coverage decisions.

Overall use of genomic testing among Medicare cancer patients remained relatively low. However, uptake nearly tripled from 6% in 2016 to 16.7% in 2023 following Medicare’s coverage decisions. The largest increase occurred among individuals with lung cancer, where NGS testing is the predominant genomic testing approach. In contrast, breast cancer patients continued to rely more heavily on non‑NGS genomic tests, reflecting differences in clinical practice and test availability.

The study also uncovered differences in testing uptake. Rates varied by age, race, ethnicity and geography, suggesting that factors beyond insurance coverage — such as provider awareness, regional resources, and patient education — may continue to influence who receives genomic testing.

“One limitation of our study is that we cannot directly compare Medicare with the overall U.S. population because our analysis included only older adults enrolled in traditional Medicare,” says Kang. “However, one finding that surprised our team was that NGS use and the growth in its uptake remained quite low across all five cancer types we studied, despite national Medicare coverage for these tests. This suggests that insurance coverage alone may not be sufficient to ensure broad adoption of precision medicine.”

Kang said that genomic testing is evolving rapidly as new targeted therapies and clinical evidence emerge. The authors recommend further research to evaluate how increased testing translates into improved outcomes and cost‑effectiveness. They also urge policymakers to consider how coverage policies can support the adoption of other emerging precision medicine technologies.

“Our next goal is to understand why genomic testing, and more specifically, NGS, remains underused and why uptake differs across cancer types and regions. We also plan to study whether receiving genomic testing ultimately leads to greater use of precision therapies and better patient outcomes,” concludes Kang.

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This work was supported by the National Institute for Health Care Management Foundation.

In addition to Kang, study researchers include Rui Zhang, Chul Kim, Marc D. Schwartz, Jaeil Ahn, Arnold L. Potosky, and Carole Roan Gresenz, all from Georgetown University.

Kang reports receiving fees from the Colorado Consumer Health Initiative, Genentech, and Garner Health.