AMCP: Include biomarker testing in coverage decisions

Launched in December 2012, the NCCN Biomarkers Compendium contains information designed to support decision-making around the use of biomarker, or molecular, testing in patients with cancer. It was the headliner for a presentation by industry experts in Session 310.

More than 2,000 tests are available to help clinicians determine optimal treatment based on patient-specific variables. The use of biomarker testing has grown for solid tumors but is rapidly evolving in practice.

 “NCCN developed the Biomarkers Compendium to ensure access to tests that influence standard treatment decisions in a rapidly evolving field of medicine,” said Joan McClure, senior vice president, clinical information and publications, National Comprehensive Cancer Network (NCCN), a panelist.

The network includes 25 academic cancer centers across the United States, including Yale Cancer Center and the Mayo Clinic.

The presentation provided an introduction to biomarker testing and also focused on the key features and current applications of the compendium, which will be able to incorporate new cancer biomarkers as they emerge. By reviewing and weighing evidence, alliance members assign categories to recommendations.

McClure says the session provided attendees an increased appreciation for the complexity of biomarker testing and its role in assuring payers that the tests they are being asked to pay for are clinically useful for patient management.

“In addition, payers should realize that regulatory decisions about tests and test kits do not adequately address this issue,” she says. 

The compendium provides essential details for tests that have been approved by NCCN guideline panels and recommended by the guidelines. These tests measure changes in genes or gene products and are used for diagnosis, screening, monitoring and surveillance or for providing predictive or prognostic information. 

McClure anticipates that payers may eventually use the Compendium as a reference for coverage decisions, similar to the way they rely on the NCCN Drugs & Biologics Compendium. The latter contains scientifically derived information designed to support decision-making about the appropriate use of drugs and biologics in patients with cancer.

Although the tool offers evidence based on research by experts, NCCN urges clinical professionals to apply independent medical judgment in their decisions about treatment that meets the clinical characteristics and needs of individual patients with cancer.

"Payer awarenes is rising, as it should be," said Mark Green, MD, of Xcenda, which studied the acceptance and awareness of the tool. 

Dr. Green also said that oncology physicians have low awareness of the compendium, which is a wake up call for the alliance.