Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

The pharmaceutical industry spent two decades building precision oncology. Targeted therapies. Companion diagnostics. Biomarker-driven trials with survival curves that sounded like science fiction in 2005. The science delivered.

A cohort study of 63,294 patients published April 7 in JAMA Network Open tells the other half of the story. Across the five most common advanced cancers, most patients never received next-generation sequencing. Metastatic breast cancer, 34.5 percent tested. Metastatic prostate cancer, 44.5 percent. Metastatic pancreatic cancer, 51.2 percent. Advanced non-small cell lung cancer and metastatic colorectal cancer topped the list and still left nearly 40 percent of patients untested.

The precision machine runs. Half the patients never walk through the door.

Genomic sequencing functions as the clinical access point for targeted oncology therapy. No sequence, no match. No match, no targeted treatment.

Breakthrough drugs sit on formularies right now and require genomic evidence to prescribe. The drugs exist. The drugs work. The path from the right patient to the right drug runs through a test most patients never receive.

Commercial teams at pharma companies model addressable market from diagnosis data. That model overstates reality by half. The real constraint lives upstream of diagnosis volume. The constraint sits at testing access, and almost nobody measures it at the patient services level.

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The Huntsman Cancer Institute team analyzed electronic health records across roughly 280 cancer clinics and 800 US sites of care through the Flatiron Health Research Database. Diagnosis years 2018 through 2022. Testing rates climbed across every cancer type. Testing rates still left most patients behind.

The disparities repeat with discipline.

Black patients waited roughly 40 percent longer than White patients for sequencing in advanced non-small cell lung cancer and metastatic colorectal cancer, and 50 percent longer in metastatic pancreatic cancer.

Hispanic patients faced comparable delays in metastatic breast, prostate, and colorectal cancers.

Medicare coverage extended time to testing across all five cancer types. Medicaid coverage doubled the wait in metastatic prostate cancer.

Patients in the lowest socioeconomic quintile waited roughly 60 percent longer for sequencing in advanced non-small cell lung cancer, with similar patterns in breast and colorectal.

One cohort. Five tumor types. Same pattern every time. The United States runs a two-tier oncology system in plain sight, and the dividing line tracks income, insurance, and race with more precision than any biomarker in the study.

Insurance requires documented genetic alteration to approve a targeted therapy. Prior authorization creates barriers to the test that documents the alteration. The patient cannot secure coverage approval without the test result. The patient cannot secure the test without clearing prior auth. The loop runs while the cancer advances.

A system designed this loop on purpose or through neglect. Either way, the design prioritizes administrative convenience over patient survival.

Community oncology sits at the widest point of the gap. Clinicians carry fewer resources, thinner staffing, and less institutional support to fight prior auth battles on diagnostics. The study authors flagged exactly this point. Breakthrough science reaches patients through community oncologists, and those clinicians need infrastructure that matches the complexity of the therapies they now prescribe.

Four moves separate companies that close access gaps from companies that fund awareness campaigns and call it advocacy.

ELAVAY: Advocacy Intelligence benchmark data shows patient advocacy organizations grade their pharma partners on whether the companies close real access gaps or fund logos on websites. The advocacy community notices the difference. Procurement decisions follow the notice.

Ask one question inside your organization this week. Who owns the sequencing gap?

If the answer is nobody, that answer costs patients access to drugs they qualify for and costs your company market share you already earned in clinical development. The gap pays out either way. Somebody captures the patients who currently fall through. That somebody should be the company that funded the science in the first place.

The companies that move now build infrastructure that delivers both patient access and competitive advantage in a single motion. The companies that wait will fund the catch-up years from now on.

If you want to evaluate how your advoacy function is standing out as being the difference maker your company needs, or if you’re being pushed to the back of the line - and what to do about it - check out the Advocacy Influence Diagnostic today. 5 minutes. Actionable Results. Strategy session to follow if desired!

Contact [email protected] to build sequencing access into your patient services and market access strategy.