Australia has a new genomics framework. But will patients see the difference?

The government has released the National Health Genomics Policy Framework and Implementation Plan 2026–2030, jointly developed by the federal and state governments, with input from consumers, clinicians, researchers and industry.

One of the most contentious blind spot is that the plan appears over-invested in consultation, mapping and further evidence gathering relative to the hard decisions needed for delivery in routine care.

Funding is an obvious fault line. The plan recognises the need for sustainable resourcing and “fit-for-purpose funding models and pathways”, but largely leaves the funding and commissioning mechanisms to be developed. Without clear funding for testing, interpretation, counselling, infrastructure and downstream care, genomics risks remaining concentrated in specialist services and pilots rather than becoming routine across the health system.

A further blind spot is whether the plan has underestimated the operational disruption of mainstreaming genomics. Routine genomics will change clinical workflows, laboratory demand, workforce roles, referral pathways and responsibility for interpreting and acting on results. The Plan focuses strongly on building capability, education and collaboration, but is less specific around a sufficiently powerful national delivery architecture.

Precision oncology is clinically mature, with genomics increasingly integral to diagnosis and treatment. The challenge is no longer clinical utility, but navigating fragmented funding, including the MBS, and achieving the scale and coordination needed for consistent national access. To improve the transition of genomics from research to clinical service delivery, Genomics Australia was established within the Department of Health on 1 July 2025.

Australia’s HTA framework was built for relatively linear decisions: assess a test, link it to a defined clinical intervention, and determine its value. Genomics is fundamentally more complex. One genomic analysis can simultaneously inform diagnosis, reveal several clinically significant variants, guide different treatment pathways, prevent ineffective therapy and identify opportunities for clinical trial participation.

The experience of ctDNA and cancer of unknown primary (CUP) illustrates the limitations of applying that traditional framework to genomic medicine. The assessment process can require applicants to account for the impact of a single genomic test across multiple therapies, despite the underlying evidence and funding arrangements being organised around individual medicines. These interdependencies extend well beyond the remit of any single applicant, creating a structural problem that cannot be resolved simply by asking companies to provide more evidence.

Patients experience the consequences of this mismatch. Oncologists must explain why a relevant test is available but not reimbursed, manage delays and difficult financial choices, or make treatment decisions without complete molecular information. This compounds inequity and prevents the scale needed to reduce costs and build sustainable access.

InGeNA’s international comparisons indicate that Australia is the only comparable OECD country that continues to rely principally on its routine HTA processes for genomic tests rather than adapting its assessment and commissioning approach. Other jurisdictions have introduced mechanisms such as national genomic test directories, central commissioning, national clinical pathways or coverage with evidence.

England’s National Genomic Test Directory provides a useful example of how assessment, commissioning and clinical delivery can operate as a connected and continuously updated system. It gives clinicians and patients clarity about which tests are available, for whom and through which pathway. The directory matters, but it is the visible component of a broader fit-for-purpose genomic assessment and commissioning model.

As InGeNA prepares to welcome Dame Professor Sue Hill to Australia in October 2026, the discussions about the NHS model have highlighted the value of a focused and efficient national function supporting the Genomic Test Directory. Its indicative annual operating cost to be approximately £400,000, covering the review and updating of tests and support for commissioning decisions. The lesson is not that Australia should simply copy England, but that a fit-for-purpose system can combine rigour, national consistency and practical access.

A panel at the recent Private Cancer Physicians of Australia Cancer Summit was asked to identify one action for the next 12 months. For InGeNA’s CEO, Dr Erin Evans, it is to commission an evaluation of the NHS model and other effective OECD approaches, and use that learning to design a fit-for-purpose HTA and commissioning system for genomics. The priority is a future-focused, dynamic system that continually assesses, records and updates access decisions, “not a retrospective exercise to reconstruct fragmented historical data”.

The government now has a national genomics framework, with the Health Chief Executives Forum (HCEF) overseeing the delivery of it. What remains curious over the five years is whether policymakers are willing to move beyond more consultations and mapping, and allocate the necessary funding and resources to meaningfully improve equitable access to genomics in routine practice.

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