A study published in the Journal of the National Comprehensive Cancer Network examined payers' reluctance to cover hereditary cancer panels.
UC San Francisco researchers interviewed 11 major payers, covering approximately 160 million patients. They then analyzed the interviews to describe their findings.
Here's what they found.
1. Researchers found several barriers to HCP coverage including:
- Coverage frameworks — 100 percent
- Insufficient evidence — 100 percent
- Departure from pedigree/family-history-based testing toward genetic screening — 91 percent
- Lacking rigor in the HCP hybrid research/clinical setting — 82 percent
- Patient transparency and involvement concerns — 82 percent
2. Researchers identified several ways payers believe they can adjusted the barriers including:
- Refining HCP-indicated populations — 82 percent
- Developing evidence of actionability — 82 percent
- Pathogenicity/penetrance — 64 percent
- Creating infrastructure and standards for informing and recontacting patients — 45 percent
- Separating research from clinical use in the hybrid clinical-research setting — 44 percent
- Adjusting coverage frameworks — 18 percent
Researchers concluded, "Leveraging opportunities suggested by payers to address HCP coverage barriers is essential to ensure patients' access to evolving HCPs."
The researchers recommend payers address insurance coverage to secure future access to PMI discoveries, incorporate payers' evidentiary requirements into PMI's research agenda and leverage the payers' recommendation to keep patients informed.