News|Articles|May 27, 2026

Medicare FFS Patients More Likely to Receive Broad Genomic Profiling

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Key Takeaways

Fee-for-service beneficiaries had higher BGP use than Medicare Advantage (25.8% vs 24.6%; AOR 1.08), indicating payer structure may influence access to guideline-recommended testing.
Only 25.3% of metastatic patients received BGP within the assessed window, underscoring persistent underuse despite national recommendations for multiple tumor types.
Lung, pancreatic, and colorectal cancers showed the highest BGP uptake, consistent with clearer therapeutic actionability and longer-standing guideline emphasis in these diseases.
Hospital referral region rates varied markedly (13.8%–35.9%), suggesting local practice culture, infrastructure, and awareness drive inequities beyond insurance design.
Embedding appropriate BGP metrics into value-based payment and quality reporting could mitigate underuse, complemented by regionally targeted educational interventions to improve guideline adherence.

Medicare FFS beneficiaries with metastatic cancer received broad genomic profiling more often than MA patients.

Medicare fee-for-service (FFS) beneficiaries were more likely to receive broad genomic profiling (BGP)—nationally recommended for several metastatic cancers—when compared with Medicare Advantage (MA) beneficiaries.¹

These findings, newly published in JAMA Network Open, came from the first study to comprehensively assess payer-related variation in BGP use. It aimed to further understand the barriers associated with BGP underusage, specifically among pay policy plans, geographic variation, and the structure and culture of local health systems.

Other studies suggest that cancer variability itself may also contribute to BGP underusage, as cancers like melanoma or breast cancer do not see the upfront impact of BGP as frequently as those with long-standing recommendations like lung or pancreatic cancer.²

This study, however, specifically evaluated BGP usage among MA beneficiaries and Medicare FFS beneficiaries.¹ Currently, MA beneficiaries account for the majority of Medicare enrollments. Since MA plans are subsidized by corporate entities, the plans tend to favor health care spending limits. These restrictions can also elicit barriers to high-quality cancer care, delay treatment initiation, and reduce survival among patients with certain metastatic cancers.

Researchers used data from Medicare beneficiary claims, the CMS assessment database, and the Chronic Conditions Data Warehouse. The study population consisted of patients aged 66 years and older and had 1 of the 10 most common solid cancers: bladder, breast, colorectal, endometrial, kidney, lung, melanoma, pancreatic, prostate, and thyroid. Claims considered for evaluation were billed between January 1, 2020, and June 30, 2022.

BGP use was assessed in the 2 months before and through 6 months after the patient’s initial cancer diagnosis.

There were a total of 254,720 patients with metastatic cancer included in the analysis, 142,083 (55.8%) of whom were enrolled under FFS Medicare and 112,637 (44.2%) under MA. The median age was 74 years, and 55.7% were female. Regarding race, 0.3% were American Indian or Alaska Native, 2.6% were Asian or Pacific Islander, 6.3% were Hispanic, 9.4% were non-Hispanic Black, 78.8% were non-Hispanic White, 0.9% identified as other race or ethnicity, and 1.7% identified as unknown race or ethnicity.

There were 64,351 (25.3%) patients who received BGP. Of them, 36,633 were FFS beneficiaries, and 27,718 were MA beneficiaries. Similar to prior studies, those with lung, pancreatic, and colorectal cancers had the highest usage of BGP.

Overall, FFS beneficiaries were more likely to receive BGP testing when compared with MA beneficiaries (36,633 of 142,083 [25.8%] vs 27,718 of 112,637 [24.6%]; adjusted OR [AOR], 1.08 [95% CI, 1.06-1.10]).

Additionally, researchers observed a significant difference in hospital region referral for BGP usage. There was considerable variation, ranging from 13.8% to 35.9% (median, 24.5%; IQR, 21.8%-27.6%). The ranges also differed between FFS beneficiaries, with a range of 13.9% to 38.3% (median, 24.8%; IQR, 22.2%-28.2%), and MA beneficiaries, with a range of 14.2% to 34.6% (median, 24.0%; IQR, 21.4%-27.3%).

This study was limited by its reliance on billing codes to determine BGP use, which may have led to missed BGP testing and incorrect identification of a BGP test. Researchers were also unable to stratify patients by specific histopathologic cancer type, which would further help to inform BGP testing in clinical practice.

“Incorporating measures of appropriate BGP use into value-based payment models or quality reporting programs could help reduce underuse among eligible patients,” the authors concluded. “Beyond payer policy, the remarkable regional variation in BGP also underscores the need for interventions to ensure equitable access to BGP nationwide, such as regionally targeted educational initiatives to improve awareness of guideline recommendations for BGP.”

References

1. Chow RD, Rothen J, Long JB, et al. Medicare Insurance Type and Broad Genomic Profiling in Metastatic Cancer. JAMA Netw Open. 2026;9(5):e2614919. doi:10.1001/jamanetworkopen.2026.14919

2. Wang X, Rothen J, Huang S, et al. Adoption of Broad Genomic Profiling in Patients With Cancer. JAMA Oncol. 2025;11(6):666–668. doi:10.1001/jamaoncol.2025.0499