Next Article in Journal
Individual Oral Therapy with Immediate Release and Effervescent Formulations Delivered by the Solid Dosage Pen
Next Article in Special Issue
Personalized Health Care as a Pathway for the Adoption of Genomic Medicine
Previous Article in Journal / Special Issue
An Altered Treatment Plan Based on Direct to Consumer (DTC) Genetic Testing: Personalized Medicine from the Patient/Pin-cushion Perspective
Article Menu

Export Article

Open AccessArticle
J. Pers. Med. 2012, 2(4), 201-216; doi:10.3390/jpm2040201

Insurance Coverage Policies for Personalized Medicine

Duke University, Institute for Genome Sciences & Policy, Durham, NC 27708, USA
*
Author to whom correspondence should be addressed.
Received: 31 August 2012 / Revised: 16 October 2012 / Accepted: 17 October 2012 / Published: 30 October 2012
View Full-Text   |   Download PDF [447 KB, uploaded 30 October 2012]

Abstract

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. View Full-Text
Keywords: personalized medicine; insurance; adoption personalized medicine; insurance; adoption
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

Scifeed alert for new publications

Never miss any articles matching your research from any publisher
  • Get alerts for new papers matching your research
  • Find out the new papers from selected authors
  • Updated daily for 49'000+ journals and 6000+ publishers
  • Define your Scifeed now

SciFeed Share & Cite This Article

MDPI and ACS Style

Hresko, A.; Haga, S.B. Insurance Coverage Policies for Personalized Medicine. J. Pers. Med. 2012, 2, 201-216.

Show more citation formats Show less citations formats

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
J. Pers. Med. EISSN 2075-4426 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top