Targeted Therapies for Lung Cancer Are Underused in Patients on Medicaid

Targeted therapies for metastatic non-small cell lung cancer are being underused in some patients covered by Medicaid, according to recent study results.

“This study suggests that targeted therapies are underused in many state Medicaid programs, limiting the access to efficacious treatments,” the authors wrote in the study, which was published in the journal, JAMA.

Targeted therapies for EGFR- and ALK-mutated metastatic lung cancer have significantly improved outcomes for some patients. However, the actual usage of these therapies is lower among patients on Medicaid, and data is lacking on how effective they are in these groups.

The researchers analyzed data from the Medicaid Drug Utilization Database between the years 2020 and 2021, and found that targeted therapies were utilized in only 66% of eligible patients on Medicaid.

This could mean that some patients on Medicaid are not able to access the treatment that is effective and needed for this disease, the study authors highlighted.

“…Suggesting that at least 500 Medicaid patients with a diagnosis of EGFR- or ALK-altered metastatic non-small cell lung cancer during these years did not receive targeted therapy when indicated. Given the efficacy of targeted therapies, this underuse could have led to an estimated 855 prevented years of life lost during the period of analysis,” they wrote.

Rates of targeted therapy usage varied by state and 91% had a lower use rate than was expected. The study authors noted that this variation was associated with factors such as Medicaid policies, the density of oncologists and state gross domestic product per capita, by state.

This may include inadequate coverage of genomic testing, which may prevent physicians from discovering what patients have these alterations — which is a requirement to receive these therapies in some states, the authors noted. Prior authorization processes could also prevent the use of targeted therapies in these patients.

“State policies and characteristics were associated with the observed variation, indicating where interventions could improve access to treatment and outcomes for patients with non-small cell lung cancer,” they wrote.

Of note, the study did have limitations including no access to individual claims and medical records, so no exact number of patients with this alteration and disease could be determined. There was also no exact determination of how many patients filed a perception for the therapies.

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