Insurance coverage policies for personalized medicine.

Published online

Journal Article

Adoption of personalized medicine in practice has been slow, in part due to the lack of evidence of clinical benefit provided by these technologies. Coverage by insurers is a critical step in achieving widespread adoption of personalized medicine. Insurers consider a variety of factors when formulating medical coverage policies for personalized medicine, including the overall strength of evidence for a test, availability of clinical guidelines and health technology assessments by independent organizations. In this study, we reviewed coverage policies of the largest U.S. insurers for genomic (disease-related) and pharmacogenetic (PGx) tests to determine the extent that these tests were covered and the evidence basis for the coverage decisions. We identified 41 coverage policies for 49 unique testing: 22 tests for disease diagnosis, prognosis and risk and 27 PGx tests. Fifty percent (or less) of the tests reviewed were covered by insurers. Lack of evidence of clinical utility appears to be a major factor in decisions of non-coverage. The inclusion of PGx information in drug package inserts appears to be a common theme of PGx tests that are covered. This analysis highlights the variability of coverage determinations and factors considered, suggesting that the adoption of personal medicine will affected by numerous factors, but will continue to be slowed due to lack of demonstrated clinical benefit.

Full Text

Duke Authors

Cited Authors

  • Hresko, A; Haga, SB

Published Date

  • October 30, 2012

Published In

Volume / Issue

  • 2 / 4

Start / End Page

  • 201 - 216

PubMed ID

  • 25562360

Pubmed Central ID

  • 25562360

International Standard Serial Number (ISSN)

  • 2075-4426

Digital Object Identifier (DOI)

  • 10.3390/jpm2040201

Language

  • eng

Conference Location

  • Switzerland