All PlansCoverageMedium impact
Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Prostate Cancer (BRCA1/2, Homologous Recombination Repair Gene Alterations, NTRK Gene Fusion)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Urology·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage criteria for germline and somatic biomarker testing (including liquid biopsy) for targeted treatment in prostate cancer, specifically for BRCA1/2, homologous recombination repair gene alterations, and NTRK gene fusion testing. This affects billing for genetic testing and targeted therapies for metastatic castrate-resistant prostate cancer patients.
Action Required
Immediately: Review new coverage criteria for prostate cancer biomarker testing including BRCA1/2, HRR gene alterations, and NTRK gene fusion testing. Billing team must verify FDA-approved companion diagnostic tests are used (FoundationOne CDx, BRACAnalysis CDx, FoundationOne Liquid CDx) when submitting claims for targeted therapies like olaparib, rucaparib, niraparib, talazoparib, larotrectinib, and entrectinib. Update prior authorization workflows to include biomarker test results for metastatic castrate-resistant prostate cancer treatments.