UCSF

TRANSPERS Program on Coverage and Reimbursement: Systematic Reviews of Payer Coverage Policies

A major focus of the TRANSPERS Center is coverage, reimbursement, and policy decisions by payers on Precision Medicine. To further our work in this area, we conduct systematic reviews of payer coverage policies, which systematically synthesize aspects of payer coverage policies on multi-gene panels and sequencing tests (“panels”) in order to be able to assess which panels are covered by payers, what factors relevant to coverage decisions are discussed in policies, and how coverage policies vary. We examine a range of coverage policies across multiple private and public payers and across policies that pertain to a broad range of tests and testing indications.

PDF iconPrintable Summary: Payer Coverage Registry (PDF)

Examples of published systematic reviews: 

  1. Douglas MP, Gray SW, Phillips KA. Private Payer and Medicare Coverage Policies for Circulating Tumor DNA Testing in Cancer Patients: Trends from 2015-2019. Journal of the National Comprehensive Cancer Network. 2020;18(7):866-872.
  2. Trosman JR, Douglas MP, Liang S, Weldon CB, Kurian AW, Kelley RK, Phillips KA. Insights from a Temporal Assessment of Increases in U.S. Private Payer Coverage of Tumor Sequencing from 2015 to 2019. Value Health. 2020;23(5):551-558.
  3. Douglas MP. Parker S. Trosman JR. Slavotinek AM. Phillips KA. Private Payer Coverage Policies for Whole Exome Sequencing (WES) in pediatric patients: trends over time and analysis of evidence cited. Genet Med. 2019;21(1):152-160.
  4. Trosman J, Weldon C, Douglas M, Kurian A, Kelley R, Deverka P, et al. Payer Coverage of Hereditary Cancer Panels: Barriers, Opportunities, and Implications for the Precision Medicine Initiative. Journal of the National Comprehensive Cancer Network; 2017:15(2):219-228.
  5. Dervan A, Deverka PA, Trosman JR, Weldon CB, Douglas MP, Phillips KA. Payer Decision-Making for Next Generation Sequencing-Based Genetic Tests: Insights from Non-Invasive Prenatal Screening. Genet Med. 2017:19(5):559-567.
  6. Phillips KA, Trosman JR, Weldon CB, Chambers J, Deverka PA, Douglas MP. Payer coverage policies for multigene tests. Nat Biotechnol. 2017:35(7):614-617.
  7. Chambers J, Saret C, Anderson J, Deverka PA, Douglas MP, Phillips KA. Examining Evidence in U.S. Payer Coverage Policies for Multi-Gene Panels and Sequencing Tests. Int J Technol Assess Health Care. 2017:33(4):534-540.​
  8. Clain E, Trosman JR, Douglas MP, Weldon CB, Phillips KA. Availability and payer coverage of BRCA1/2 tests and gene panels. Nat Biotechnol. 2015 Sep;33(9):900-2.

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