Cancer patients in the US and UK will soon access next-generation sequencing (NGS) as part of routine clinical care. In the US, the Centers for Medicare and Medicaid Services (CMS) finalized a plan to cover diagnostic laboratory tests using NGS for patients with advanced cancer, a move designed to increase the use of approved gene-targeted therapies, increase access to clinical trials and help oncologists and patients make informed treatment decisions. In the UK, the National Health Service will launch a new service in October 2018 to provide access to the latest in genomic testing and management for the whole country. The NHS England Board will establish a national NHS Genomic Medicine Service “making the NHS the first healthcare system in the world to systematically introduce whole genome sequencing into healthcare,” says NHS chief scientific officer for England, Sue Hill. This rollout to all patients follows from the success achieved by Genomics England's 100,000 Genomes Project, which will wind down at the end of 2018. Analyst Puneet Souda of Leerink Partners wrote in a note to investors that a boost to NGS testing is a positive for instrumentation makers which include Illumina and Thermo Fisher Scientific, and in the US it will help shape regulatory and reimbursement pathways for NGS tests for advanced cancers. Companion diagnostics should similarly benefit from having a well-defined commercialization path. When CMS first proposed its plan to cover NGS tests, some concerns were expressed by traditional laboratory test developers that under these new rules, their business would be eroded. Voices were raised, in particular, after the FoundationOne CDx, a companion diagnostic from Foundation Medicine, was approved last November to direct use of more than a dozen targeted cancer therapies (Nat. Biotechnol. 36, 124–125, 2018). But NGS coverage applies only to somatic testing for advanced cancers and therefore does not impinge on traditional tests for hereditary testing, screening and other non-advanced cancer conditions.