Payer coverage principles for precision medicine biomarker testing in oncology

Abstract

In 2025, the Academy of Managed Care Pharmacy (AMCP) held a 2-day partnership forum on the topic of advancing precision medicine access in oncology. Precision medicine, in this context, focuses on biomarker testing required to create personalized treatment plans and procedures. The forum brought together patients; payers, including health insurers and employer groups; pharmacy benefit managers; providers; pathologists; laboratory benefit managers; and leaders from patient advocacy organizations, coalitions, and professional associations. In response to fundamental coverage challenges impacting patient access to biomarker testing, the overarching goal of the forum was to collaboratively ideate deliverables to drive a standardized approach to assessing and determining coverage. A critical deliverable from this initiative included 8 guiding principles for managed care stakeholders as it relates to the coverage of biomarker testing. This article provides detail on each guiding principle, which are considerations intended to guide managed care decision-makers on determining and monitoring coverage for biomarker-driven testing used to inform treatment decisions in oncologic indications.