A Change in Reimbursement Is Needed for Personalized Medicine to Be Successful

This brings up some very good questions, how do you “code” treatments that come under the clinical trial area, or those not yet FDA approved. Most labs have been using genetic based tests for a while now and as it states here, there is no way to determine which is a genetic test and which uses other technologies.

As personalized medicine continues to grow, this no doubt will be an ongoing issue on how to determine how to code to enable reimbursement and will require a more active role from the insurers as well so treatment is not delayed for the purpose of researching such. This occurs today and treatment plans are delayed for the sake of obtaining additional information and as more tests are in use and approved, this no doubt will continue to grow. BD

It is difficult to figure out how to reimburse [genetic tests] with the coding system we have," maintained Armstrong. In the current system, "you can't distinguish one genetic test from another because they all use the same CPT [i.e., Current Procedural Terminology] code.

….We need to tie reimbursement strategies to best practices. We need to have partnerships with health plans and health care-delivery settings."