In partnership with the Blue Cross Blue Shield Association, Concert Genetics, and Illumina, Inc., the Personalized Medicine Coalition (PMC) is pleased to release a new report that compares real-world health insurance claims for genomic testing with applicable coverage policies in the United States. The report shows that while wide variation and a lack of clarity in payer coverage policies may present barriers to the utilization of genomic testing, such testing is inconsistently utilized even among states where favorable coverage policies exist. The findings suggest that a broader range of clinical adoption challenges are complicating efforts to integrate genomic testing into clinical work streams.
Based on the ability of genomic testing to efficiently detect the presence of genetic variants associated with inherited diseases and certain cancers, the report, titled Understanding Genomic Testing Utilization and Coverage in the US, examines applicable commercial coverage policies and de-identified health insurance claims submitted for genomic testing for non-invasive prenatal screening, diagnosis of suspected rare diseases, and genomic profiling of advanced cancers. The findings show that:
- Medically appropriate genomic testing is inconsistently utilized across U.S. states;
- Payer genomic testing coverage policies vary considerably among states;
- Favorable coverage policies do not always correlate with higher utilization rates across states; and
- Inconsistent coverage and reimbursement policies remain barriers to genomic testing access, but do not entirely explain inconsistent utilization.
Based on the available literature, the report outlines a broader range of administrative, educational, and technical challenges that are likely discouraging the use of genomic testing in clinical settings.
Quotes about the report from representatives of Concert Genetics, Illumina and the Personalized Medicine Coalition are presented below.
“This report brings greater transparency to a complex and critically important area of health care. In doing so, it is clear that more innovation is needed to deliver the promise of precision medicine to U.S. health care consumers.”
– Rob Metcalf, CEO, Concert Genetics
“This important study highlights that increased adoption takes more than just favorable coverage policies. Creating awareness through partnership, education and outreach initiatives is an important step to ensuring people understand the power of precision medicine.”
– Ammar Qadan, Vice President of Global Market Access, Illumina
“Understanding Genomic Testing Utilization and Coverage in the US reminds us that we need to address a wide range of clinical adoption issues in order to facilitate more widespread utilization of the tests and treatments underpinning personalized medicine, which benefits patients and health systems by targeting treatments to those who will benefit.”
– Edward Abrahams, President, Personalized Medicine Coalition
