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Many lung cancer patients on Medicaid don’t receive up-to-date effective therapy

About one third of Medicaid patients with metastatic non–small cell lung cancer, the most common type of lung cancer, are not receiving new FDA-approved targeted therapy, a new study of Medicaid programs suggests.

Targeted therapy is a treatment for patients who have certain abnormalities in their tumors. Some new lung cancer treatments can “target” these changes directly while often causing fewer side effects because they focus on targeting what is exactly wrong with the cancer cell, instead of killing normal, healthy cells too.

Researchers found that the rates of targeted therapy use among those with mutations in the genes called EGFR and ALK varied widely across U.S. states in 2020 and 2021, with only 18% of eligible Medicaid patients in Arkansas receiving appropriate targeted therapies. In only three states were dispensing volumes in line with expected levels, while in 12 states, dispensing volumes were “somewhat below” expected levels, and in 18 states, the volumes were “substantially below expected levels,” the researchers found.

Despite being required by federal law to cover drugs for almost all indications approved by the US Food and Drug Administration, financial concerns have prompted some Medicaid programs to reduce the services provided, including the use of costly drugs. Research indicates that rates of guideline-concordant care are in fact lower among Medicaid patients and that the access that these patients have to evidence-based oncology care varies across the U.S.

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