Every year, about 1.9 million cancer cases are diagnosed in the United States.¹ As the field of precision oncology — which seeks to more accurately identify and treat this disease — continues to grow, evolve and become more complex, providers need to keep pace with testing and targeted treatment options. About 73% of oncology drugs in the pipeline are for precision medicine.² And time is of the essence, as patients want to begin effective therapies as soon as possible. Therefore, quickly matching patients with the treatment most likely to work for them can improve outcomes and reduce unnecessary therapies. 

However, the patient journey may be lengthy and sometimes complicated. For many cancers, biomarker testing — an analysis of changes to the cancer genes or DNA, or the presence of proteins made by cancer cells — is used to identify the type of cancer and guide treatment decisions. In a recent study highlighted in the latest Prime Therapeutics Report, Prime experts found it takes an average of 45 days from biomarker testing to therapy initiation for cancer patients. 

To better understand the lag between biomarker testing and treatment, researchers dug into the targeted therapy prior authorization submissions for 450 members. They found there may be delays in obtaining samples when a patient transfers care organizations, tissue samples are insufficient and the testing process is slow, among other roadblocks. The solution to optimizing the care journey may lie in getting providers, testing labs and payers on the same page.

“Biomarker testing is one of the newest frontiers in cancer care, and Prime is optimizing its ability to match patients with the right targeted therapy so no time is lost,” said Simone Ndujiuba, PharmD, BCOP, clinical oncology pharmacist senior principal at Prime. “Our innovative clinical decision-support product removes the guesswork and presents actionable, guideline-recommended solutions.” 

Prime’s novel solution to help improve the cancer patient journey

By 2034, the U.S. precision medicine market will reach as much as $469.16 billion.³  New discoveries lead to continuous changes to biomarker testing recommendations. However, many studies show providers face challenges to keep up with these changes. The wide variety of laboratory test panels makes it difficult for physicians to determine which panels contain all recommended biomarker tests that are needed. 

In one study, more than two-thirds of community oncologists either didn’t know or incorrectly matched the molecular alteration to the targeted therapy.⁴  So, they ordered large or multiple panels that contained non-actionable tests or duplications, which lead to increased cost. 

Payers are concerned about this rising cost and would like to drive toward biomarker testing to identify the exact mutation so a provider can prescribe the best therapy for each patient. 

Prime offers a number of solutions designed to simplify the patient journey, help members and clients save on life-saving medications and support those receiving cancer care to live their best lives. For example, Prime’s Precision Oncology product, powered by Trapelo Health, offers biomarker testing management for patients diagnosed with cancer, including targeted therapy selection for both pharmacy and medical benefit drugs. This solution helps reduce administrative burden and decrease the time it takes to connect a patient with the best treatment for their condition. More than 500 oncologists rely on the clinical decision support tool. Additionally, more than 1,200 total platform users across 125 locations have achieved a 98% concordance rate with treatment guidelines. Because of the platform — which generates 3,200 test decisions a month — the in-network utilization of molecular testing increased from 53% to 70%.

By harnessing the power of Prime’s digital solutions, providers can work more efficiently to provide effective therapy for patients, including the appropriate use of targeted therapies informed by pertinent biomarker testing. 

Learn more about this study and other timely specialty trends in the newest installment of the Prime Therapeutics Report. 

References

1. Centers for Disease Control and Prevention. (n.d.-a). Cancer Data and statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/data/index.html  
2. Krzyszczyk, P., Acevedo, A., Davidoff, E. J., Timmins, L. M., Marrero-Berrios, I., Patel, M., White, C., Lowe, C., Sherba, J. J., Hartmanshenn, C., O’Neill, K. M., Balter, M. L., Fritz, Z. R., Androulakis, I. P., Schloss, R. S., & Yarmush, M. L. (2018). The growing role of precision and personalized medicine for cancer treatment. Technology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6352312/ 
3. Precision Medicine Market will reach $469.16 billion by 2034. BIS Research. (2025, February 20). https://bisresearch.com/insights/Precision-medicine-market-is-expected-to-reach-469-billion-dollar-by-2034 
4. Laura Joszt, M. (2022, May 24). As number of targeted therapies increases, challenges with precision medicine are not going away. AJMC. https://www.ajmc.com/view/as-number-of-targeted-therapies-increases-challenges-with-precision-medicine-are-not-going-away