While it is clear that insurance companies face multiple obstacles to broadly implement WGS-favorable policies, it’s equally clear that they have as much to gain as their patients. Industry Voices—Whole-genome sequencing ultimately benefits payers, CVS study: Broad-panel sequencing lowers long-term cancer care costs, Blue Shield of California to cover rapid whole-genome sequencing for critically ill children. 3 Speen Street, Suite 300, Framingham, MA 01701. Whole Genome Sequencing (WGS) is considered experimental/investigational and therefore non-covered for all indications. Beginning Jan. 1. This highlights a second obstacle: the lack of consistent guidelines for evaluating sophisticated genetic testing technologies, including WGS testing. As an example, consider the situation described above where “rapid” WGS is covered in a NICU setting where all parts of the genome are recognized as clinically useful, but, when used to treat these same patients in a different setting of care, WGS is considered experimental. Finally, we would like to extend our thanks to the British In Vitro Diagnostics Association, the Medical Research … Use a + to require a term in results and - to Juha … Having a small number of generic codes makes it exceedingly difficult for insurance companies to evaluate exactly what the genetic test is for and whether it is warranted. Genomic medicine has the capacity to revolutionize clinical practice. In the pediatric outpatient setting, when either whole exome sequencing … Without this information, insurers cannot properly assess how to reimburse for genetic tests. Visit NHGRI's Genome Statue and Legislation Database to search for these laws state-by-state. In the absence of descriptive, transparent coding it becomes difficult for insurance companies to make informed decisions regarding payments, which often leads to a default position of denying coverage. One challenge insurers face is the difficulty of deciding when to reimburse for genetic tests that health care providers have offered their patients. The key difference between whole genome sequencing and exome sequencing is that the whole genome sequencing sequences the entire genome of an organism while the exome sequencing sequences only the exome or the protein-coding genes of an organism.. Sequencing … Additionally, there is a lack of extensive data evaluating the economics of genetic testing. The reason this is difficult is that insurers may not be able to easily evaluate what type of genetic test was performed, whether the test was appropriate to perform and whether the test is scientifically valid. The mapping of the human genome has created new opportunities for genetic tests to predict, prevent and treat disease. Other tests can predict optimal chemotherapy regimens, or predict the likelihood of drug response or toxicities and avoid exposing patients to ineffective or overly toxic regimens. RELATED: CVS study: Broad-panel sequencing lowers long-term cancer care costs. All rights reserved. This is in part because procedures are billed according to a standardized system of Current Procedural Terminology (CPT) codes developed by the American Medical Association, and fewer than 200 CPT codes exist for about 70,000 genetic tests. Advantage Whole Genome Sequencing (WGS) requires prior authorization. CDC’s Division of Foodborne, Waterborne, and Environmental Diseases uses this information to … Health insurance providers are stuck in the same drawn-out “odyssey”, spending regularly for costly visits and tests. Until recently, many patients with inherited disorders had no option but to follow a long, arduous and costly “diagnostic odyssey.” This odyssey often takes them from one specialist to another and requires multiple rounds of testing which can drag on for years. Having a uniform approach will provide insurance companies with greater clarity during the evaluation process. Whole Genome Sequencing is … Evidence of clinical utility and cost-effectiveness … Even when a WGS test result is negative, the actionability is still greater as a comprehensive set of potential causes has been ruled out. While patients benefit from receiving much-needed answers sooner, insurance companies simultaneously benefit from significant cost savings. The sequencer identifies the A’s, C’s, T’s, and G’s, or … In this panel, experts will explore how pharmacists can leverage technology to automate administrative tasks and satisfy patient needs. 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