A new analysis using seven years of Medicare claims data found that adoption of next-generation sequencing (NGS) in cancer remained slower than expected after CMS began covering testing nationally in 2018, and that access gaps persisted for certain tumor types. The study, published in JAMA Network Open, evaluated NGS and non-NGS genetic testing among 391,151 Medicare beneficiaries with lung, breast, colorectal, prostate, or endometrial cancer. The report attributes continued variability in part to how Medicare national coverage applied to FDA-approved NGS tests, while lab-developed tests without FDA approval continued to rely on regional decisions even under the same national framework. That structure created uneven pathways for laboratories that offered non-FDA-authorized panels. The findings arrive as multiple testing providers expanded their FDA approvals following the national coverage determination, including Foundation Medicine, Guardant Health, Tempus, Caris Life Sciences, Thermo Fisher Scientific, Invitae, and Pillar Biosciences. Still, the persistence of gaps suggests that payer policy alone did not eliminate real-world friction around coverage, ordering behavior, and panel availability. For precision medicine stakeholders, the study strengthens the case for harmonizing coverage criteria across test types and platforms if the field’s clinical promise is to translate uniformly into practice.