Grant Summary: Building the Evidence Base for Appropriate and Equitable Reimbursement of New Genomic Testing Technologies: A Pilot Study on Tumor Profiling Tests and the UCSF500 Test

Our overall agenda was to collect evidence on reimbursement challenges and explore how those challenges could be addressed. The specific objectives for this feasibility study were to examine what data are needed and what data are available for tracking and analyzing reimbursement at the patient/clinic level. One goal was to assess the feasibility of developing a larger study to submit for grant funding. Our findings also helped UCSF’s Clinical Cancer Genomics Laboratory (CCGL) develop their testing program and reimbursement processes for the UCSF500 Cancer Gene Panel.

We achieved all of our study goals with benefits to researchers and beyond. In sum, outcomes include:

  1. Conducted a study of current testing approaches and reimbursement of tumor sequencing at UCSF
  2. Conducted a survey and hosted a webinar on the Centers for Medicaid and Medicare Services (CMS) National coverage decision (NCD) for Advanced Cancer Sequencing with our Payer Advisory Board, which includes all seven of the largest private US payers and other thought leaders.
  3. Obtained additional funding from NIH (R01 CA221870), developing a related UCSF RAP proposal, and a large UC Health System-wide proposal.

This pilot study produced 3 papers, including one in JAMA and one in Science.

  1. Phillips KA, Trosman JR, Deverka PA, Quinn B, Tunis S, Neumann PJ, Chambers JD, Garrison LP Jr, Douglas MP, Weldon CB. Insurance coverage for genomic tests. Science. 2018 Apr 20;360(6386):278-279. PMID: 29674586; PMCID: PMC5991085.
  2. Phillips KA. Evolving Payer Coverage Policies on Genomic Sequencing Tests: Beginning of the End or End of the Beginning? JAMA. 2018 Jun 19;319(23):2379-2380. PMID: 29710095; PMCID: PMC6013401.
  3. Phillips KA, Trosman JR, Weldon CB, Douglas MP. New Medicare Coverage Policy for Next-Generation Tumor Sequencing: A Key Shift in Coverage Criteria With Broad Implications Beyond Medicare. JCO Precis Oncol. 2018;2:PO.18.00206. PMID: 31073549; PMCID: PMC6503521.