Abstract: Precision medicine is responsible for improvements in outcomes and treatment for non-small cell lung cancer (NSCLC), replacing empiric cytotoxic agents with biomarker-driven regimens. Their use relies on biomarker testing, which includes assessment of oncogenic driver mutations and predictive markers of immunotherapy response. Consequently, guidelines now recommend biomarker testing across most stages of NSCLC. Despite guideline recommendations, and evidence demonstrating an association between biomarker testing and survival, underutilization and delays in biomarker testing remain an issue and can result in suboptimal treatment. A lack of knowledge of biomarkers and their therapeutic implications as well as variation in practices for ordering and coordinating testing contribute to these deficiencies. Pathologist-driven reflex testing, in which pathologists systematically initiate biomarker testing based on multidisciplinary agreements, can ameliorate many of these issues by consolidating the required knowledge to a smaller group of providers who are poised to more efficiently begin the testing process. The Veterans Health Administration (VA) is the largest integrated health system in the United States and provides free access to biomarker testing. Despite this coverage, ordering processes are not standardized across the organization. The present study was performed to characterize practices and perceptions of VA health care providers toward biomarker testing and to inform process improvements.