Are Payors Finally Heeding the Call to Offer More Responsive Policies?

Major Announcement – Medicare Makes Genetic Testing More Affordable and Accessible

“Reimbursement policies threaten the development of molecular diagnostics as a critical element in making precision medicine a reality. The payors are beginning to feel the pressure for more responsive reimbursement policies but it is up to the biomedical research and clinical communities to demonstrate the value of molecular profiling.”

Dr. George Poste, Chief Scientist, Complex Adaptive Systems Initiative (CASI), Regents’ Professor and Del E. Webb Chair in Health Innovation at Arizona State University

A major landmark decision has been announced last week, making genetic testing more accessible to Medicare and Medicaid patients by significantly reducing the patients’ responsible contribution towards the cost of some available tests, and by restructuring billing and coding policies to adapt to today’s standards of healthcare which embrace precision medicine.

This news also affects patients that might be at risk for hereditary breast cancer and related disorders – including genes such as BRCA1, BRCA2 and additional other genes – which under the new coding policy will now have access to and will be reimbursed for both single and multi-gene genetic testing using next-generation sequencing – tests that were previously out of reach for many patients.

Though still considered a small step by some, these developments indicate that we are clearly moving in the right direction. Additionally, this decision coincides with the recent news of new startups offering a series of hereditary cancer and other disease type tests at increasingly lower cost.

Of course, we are still facing many questions that need to be addressed, including:

  • How will the landscape of genetic testing be impacted or changed for the patient, payor, or molecular test provider?
  • How do we advance towards achieving a reimbursement process that is value-based versus cost-based?
  • How is the value of precision medicine and molecular testing assessed, in particular in therapeutic areas outside of oncology?
  • What is the economic impact of precision medicine on the patients, payors, pharmaceutical industry, and providers?
  • How do we communicate value-based precision medicine?

At PMWC 2017 Silicon Valley we will focus on these aspects in several sessions that are fully dedicated to these questions – another compelling reason not to miss out and join this conference.

Some of the PMWC sessions evaluating economic impact of precision medicine:

The Economics of Bringing Precision Medicine to the Clinic
Session Chair: George Poste, ASU

Personalized Medicine – The Cinderella Story of Venture Investments?
Session Chair: Mara Aspinall, Genepeeks

New Healthcare Paradigm from the $100 Genome
Session Chair: Yiwu He, BGI

Sessions that focus on generating and communicating the value of precision medicine:

How To Engage Community Oncologists in Precision Medicine
Session Chair: Lincoln Nadauld, Intermountain Health Care; Laurence Marton, PMWC 2014 Program Chair

The Last Clinical Mile of Precision Medicine – Challenges at the Point of Care
Session Chair: Assaf Halevy, 2bPrecise

Real-world Solutions to Practical Challenges When Implementing Precision Medicine Programs
Session Chair: Chris Cournoyer, N-of-One

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Roy Beveridge

Shari M. Ling
Centers for Medicare and Medicaid Services

Harold L. Paz

Nazneen Aziz
Kaiser Permanente

George Poste

Alexis Borisy
Third Rock Ventures

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