Precision Medicine Adoption Hindered by Coverage, Education Gaps

Precision medicine holds particular promise in oncology, but evolving guidelines, gaps in provider education, and inconsistent payer coverage continue to slow its adoption, according to Pamala A. Pawloski, PharmD, principal research scientist at the Academy of Managed Care Pharmacy (AMCP) Research Institute.

At AMCP Nexus 2026, Pawloski, a panelist in the session “Practice Over Promise: Payment and Coverage Access to Precision Medicine Through a Real-World Lens,” told The American Journal of Managed Care^® that some of the greatest opportunities for precision medicine are currently in oncology, particularly non–small cell lung cancer (NSCLC). With more targeted therapies and biomarkers available for testing, NSCLC offers a strong opportunity to improve patient outcomes, she said.

Pawloski noted, however, that barriers to precision medicine exist “on all levels.” Clinical guidelines frequently change and can be broad as the science advances rapidly, she said, making it difficult for providers to keep up. Payer coverage presents another challenge, as they interpret guidelines differently and have varying priorities regarding which services they will cover.

Pawloski identified policy as the primary driver of variation in coverage for genomic testing and precision medicine across Medicare, Medicaid, and commercial health plans. Medicare and Medicaid operate under established policies, while private payers develop their own coverage rules, creating inconsistencies, she said. As a result, access to testing may depend on a patient’s payer, location, and site of care.

To address these gaps, Pawloski emphasized the need to standardize precision medicine, starting with consistent terminology for its components and standardized workflows. She also called for greater use of reflex testing to improve efficiency and broader educational efforts involving payers and other stakeholders, which she said could make a significant difference.

Building trust should involve multidisciplinary, multifaceted conversations, Pawloski said. She noted that these discussions must address what services need to be covered, what evidence supports testing, and how testing should be conducted.

“…we need to bring everybody together to sit down at the table and have these conversations,” she said. “…We need to talk about both the barriers and the opportunities where we can improve. I think coming together and having those conversations is critical to making that happen.”