Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - VIRGINIA

This Humana Medicaid policy defines covered and non-covered genomic and molecular biomarker tests for cancer. It covers specified comprehensive genomic profiling and single-gene tests for hematologic and solid tumor indications (with staging and treatment-intent requirements), FoundationOne Liquid CDx under defined conditions, and select assays such as MyAML and MyMRD for AML, while excluding many newer/experimental assays (eg, paired DNA/RNA +RNAinsight tests, multiple liquid biopsy assays, certain optical genome mapping and multianalyte proprietary algorithm tests) citing insufficient evidence. This Humana coverage article (effective 2025-08-05) lists covered single-gene genomic tests and tumor marker assays for specific solid tumors, specifying clinical scenarios and therapy-eligibility conditions (e.g., FGFR3 for advanced bladder cancer to determine erdafitinib/Enhertu eligibility; PIK3CA for HR+/HER2- advanced breast cancer to determine alpelisib/inavolisib eligibility). It also defines limits such as FDA-approved test requirements for PIK3CA, age/PSA criteria for IsoPSA, and excludes des-gamma-carboxy prothrombin (DCP) testing as not eligible.