Medicare Genomic Testing Uptake Triples but NGS Gaps Persist in Cancer Care

While precision medicine has revolutionized oncology, a new analysis suggests that many older adults are missing out on the genomic testing required to access targeted therapies. A study published in JAMA Network Open reveals that although genomic testing among Medicare beneficiaries nearly tripled between 2016 and 2023, the adoption of advanced next-generation sequencing (NGS) remains low.

The retrospective cohort study, led by researchers at Georgetown University’s School of Health, analyzed claims data from 391,151 Medicare fee-for-service beneficiaries aged 66 and older diagnosed with lung, breast, colorectal, prostate, or endometrial cancer. Researchers tracked testing patterns following two landmark Medicare National Coverage Determinations (NCDs): the 2018 decision to cover somatic NGS and the 2020 expansion to include germline testing.

A Growing Trend with Persistent Gaps

The study found that the proportion of patients receiving any genomic testing rose from 6.0% in 2016 to 16.7% in 2023. Despite this growth, 91.4% of the cohort received no genomic testing within 180 days of their diagnosis.

“Genomic testing is essential for matching cancer patients to the most effective targeted therapies,” stated lead author So-Yeon Kang, PhD, MBA, MPH, an assistant professor at Georgetown, in a news release. “While genomic testing became much more common … uptake of advanced, next-generation sequencing genomic testing remained relatively low, suggesting that many patients may still not be benefiting from precision medicine.”

NGS can analyze multiple cancer-related genes simultaneously, whereas older testing methods often examine only one or a few genes at a time. However, NGS-only testing reached 2.1% of the study population by 2023.

Disparities by Tumor Type and Geography

The study highlighted significant heterogeneity across different cancers:

• Lung Cancer: This group saw the highest NGS adoption, increasing from 1.6% in 2016 to 9.2% in 2023. This reflects clear national guidelines recommending comprehensive NGS for non-small cell lung cancer.
• Breast Cancer: By 2023, breast cancer patients had the highest rate of any genomic testing (28.6%), but they relied heavily on non-NGS modalities.
• Prostate Cancer: This group had the lowest overall uptake for any genomic testing, with rates fluctuating between 2.8% and 5.1%.
• Geography: Testing was heavily concentrated in metropolitan areas (77.3%), suggesting that patients in rural regions may face significant access barriers.

The researchers noted that insurance coverage alone is not a "magic bullet." Even with national Medicare coverage, factors such as provider awareness, regional resource availability, and patient education continue to influence who receives these tests.

Key Takeaways for Oncology Nurses

• Uptake is increasing but not universal: While the 3-fold increase in testing is promising, the vast majority of Medicare beneficiaries still do not receive genomic profiling.
• NGS remains underutilized: Many patients are still receiving single-gene tests rather than comprehensive NGS, which may limit their eligibility for the latest FDA-approved targeted therapies.
• Clinical context matters: Testing rates are highest in lung cancer and lowest in prostate cancer, reflecting differences in the strength of evidence and timing of clinical guidelines.
• Coverage does not equal access: Despite national coverage, barriers such as geographic location and provider familiarity with NGS persist.

Nursing Action Items

• Screen for Eligibility: Oncology nurses should review the diagnostic workup for newly diagnosed patients—especially those with lung or colorectal cancers—to ensure genomic testing has been ordered within the clinically relevant 180-day window.
• Educate Patients: Help Medicare beneficiaries understand the difference between somatic (tumor) and germline (inherited) testing, and how these results guide personalized treatment plans.
• Advocate for Comprehensive Testing: In multidisciplinary rounds, nurses can advocate for NGS over single-gene assays when appropriate, ensuring patients have the most complete variant profile possible.
• Monitor for Denials: Be aware that nearly one-fourth of cancer-related NGS claims have historically been denied in Medicare; nurses can play a role in coordinating the documentation needed to support medical necessity.
• Address Geographic Disparities: For patients in rural or non-metropolitan areas, nurses should help identify regional centers or independent laboratories that offer NGS services.

As new targeted therapies emerge, the demand for genomic testing will only grow. "Our next goal is to understand why genomic testing, and more specifically NGS, remains underused," Kang concluded. For oncology nurses, staying informed on these trends is essential to ensuring that older adults are not left behind in the era of precision oncology.

References

1. Kang SY, Zhang R, Kim C, et al. Genomic testing uptake among Medicare beneficiaries with cancer. JAMA Netw Open. 2026;9(7):e2626078. doi:10.1001/jamanetworkopen.2026.26078
2. Georgetown University School of Health. Despite Medicare coverage, many cancer patients still do not receive testing that guides treatment options. Published July 29, 2026. Accessed July 31, 2026. https://health.georgetown.edu/news-release/despite-medicare-coverage-many-cancer-patients-still-do-not-receive-testing-that-guides-treatment-options/