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Correction: Antoniou, M.; et al. Fixed and Adaptive Parallel Subgroup-Specific Design for Survival Outcomes: Power and Sample Size. J. Pers. Med. 2017, 7, 19
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Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer

Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health; 630 Plantation Street, Worcester, MA 01605, USA
Departments of Population Medicine and Psychiatry, Harvard Medical School, Boston, MA 02115, USA
Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37232, USA
Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC 27710, USA
Author to whom correspondence should be addressed.
J. Pers. Med. 2018, 8(2), 19;
Received: 16 April 2018 / Revised: 8 May 2018 / Accepted: 10 May 2018 / Published: 16 May 2018
Insurance coverage policies are a major determinant of patient access to genomic tests. The objective of this study was to examine differences in coverage policies for guideline-recommended pharmacogenomic tests that inform cancer treatment. We analyzed coverage policies from eight Medicare contractors and 10 private payers for 23 biomarkers (e.g., HER2 and EGFR) and multi-gene tests. We extracted policy coverage and criteria, prior authorization requirements, and an evidence basis for coverage. We reviewed professional society guidelines and their recommendations for use of pharmacogenomic tests. Coverage for KRAS, EGFR, and BRAF tests were common across Medicare contractors and private payers, but few policies covered PML/RARA, CD25, or G6PD. Twelve payers cover at least one multi-gene test for nonsmall cell lung cancer, citing emerging clinical recommendations. Coverage policies for single and multi-gene tests for cancer treatments are relatively consistent among Medicare contractors despite the lack of national coverage determinations. In contrast, coverage for these tests varied across private payers. Patient access to tests is governed by prior authorization among eight private payers. Substantial variations in how payers address guideline-recommended pharmacogenomic tests and the common use of prior authorization underscore the need for additional studies of the effects of coverage variation on cancer care and patient outcomes. View Full-Text
Keywords: pharmacogenomics; multi-gene testing; cancer; insurance coverage; tumor markers pharmacogenomics; multi-gene testing; cancer; insurance coverage; tumor markers
MDPI and ACS Style

Lu, C.Y.; Loomer, S.; Ceccarelli, R.; Mazor, K.M.; Sabin, J.; Clayton, E.W.; Ginsburg, G.S.; Wu, A.C. Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer. J. Pers. Med. 2018, 8, 19.

AMA Style

Lu CY, Loomer S, Ceccarelli R, Mazor KM, Sabin J, Clayton EW, Ginsburg GS, Wu AC. Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer. Journal of Personalized Medicine. 2018; 8(2):19.

Chicago/Turabian Style

Lu, Christine Y., Stephanie Loomer, Rachel Ceccarelli, Kathleen M. Mazor, James Sabin, Ellen W. Clayton, Geoffrey S. Ginsburg, and Ann C. Wu 2018. "Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer" Journal of Personalized Medicine 8, no. 2: 19.

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