Improving Medicare reimbursement & Genetic Testing; Upcoming Conference of Interest

Letter from Director

Happy end of summer! Here at TRANSPERS, we are back in full swing: Read about our recent contributions to improving Medicare reimbursement; the important but often overlooked perspectives of genetic counselors and geriatricians on genetic testing; and an upcoming conference on precision medicine that we highly recommend. You will also find links to our new research resource on cancer and genomic medicine.



Policy and Publications

Improving Medicare’s Coverage with Evidence Development Program

“Coverage with Evidence Development” (CED) has become a flashpoint for health policy, given the recent and extremely controversial Medicare decision requiring CED for some new Alzheimer’s drugs. Despite their long history, there is little evidence to demonstrate the successful implementation of CED or to show that the results change coverage policies. TRANSPERS Director Kathryn Phillips, PhD, has been working to improve implementation and evaluation of the CED program through:
  • Serving as an advisor on the revision of the Centers for Medicare & Medicaid Services' CED guidance (which is done only every 10 years) to develop requirements that will enhance and improve CED.
  • Discussing in JAMA Health Forum how to improve CED with tracking, transparency, and assessment of value added

Survey of Genetic Counselors’ Experience with Hereditary Cancer Tests Finds Significant Disparities

In a survey of 135 cancer genetic counselors, a TRANSPERS team led by Christine Weldon, MBA, found that:
  • Most respondents (94%) ordered a hereditary cancer panel (HCP) for patients to assess cancer predisposition.
  • Most respondents (84%) indicated clinical indications and patients' requests as the main factors in selecting HCPs.
  • Only 42%, considered reimbursement and patient OOP cost as an important.
  • Respondents perceived that testing is more often reimbursed by insurance than genetic counseling, and patients are more willing to pay for testing than for genetic counseling.

The authors concluded that policy efforts should address this imbalance in reimbursement and patient OOP share. Patient-centered communication should educate patients on the benefits of genetic counseling. The survey was published in the Journal of Genetic Counseling.

Geriatricians’ Perspectives on Utility of ApoE Testing for Alzheimer’s Disease

A sample of California geriatricians interviewed by a TRANSPERS team perceived minimal clinical utility of genetic testing for Alzheimer’s Disease. The study led by Jalayne Arias, found that though geriatricians recognized the potential personal utility of testing (e.g., assisting with future financial planning), they expressed concerns regarding patients' anxiety from learning about genetic status, particularly through direct-to-consumer (DTC) testing. The decision to order genetic testing requires clinical and ethical considerations, including balancing limited clinical utility with the potential personal utility.


Hear President Barack Obama and TRANSPERS at the Illumina Genomics Forum 9/28-10/1

The Illumina Genomics Forum will present their innovation roadmap and insights from leaders in precision medicine. Kathryn Phillips, PhD, will chair a panel on ethical, legal, and social aspects of clinical genomics.” Be a part of this experience 9/28-10/1 in San Diego. Register Now!

New Research Resource on Website: Results from TRANSPERS Grant on Cancer and Genomic Medicine

TRANSPERS recently completed their National Cancer Institute grant, Coverage, Price, and Reimbursement for Multigene Tests for Cancer and Related Conditions (R01CA221870). Publications summarizes and provides links to 30 papers from this work including publications in JAMA (N=2), Science, JNCCN, Health Affairs, Genetics in Medicine (N=5), and Value in Health (theme section of 6 papers).

Upcoming Conference

Join Kathryn at National Academy of Medicine Roundtable on Genomic Data Use to Advance Precision Medicine

The Roundtable on Genomics and Precision Health in collaboration with the National Cancer Policy Forum will host a public workshop on Wednesday, October 12, 2022 (10:30 AM – 6:00 PM EDT) that will examine how genomic data are used in health care, outside of the traditional settings for clinical genetics, and to identify opportunities for advancement of precision health care delivery. This workshop will also explore how patients, clinicians, and payers assess and act upon the risks and benefits of genomic screening and diagnostic testing. The overarching goal of the workshop is to examine strategies to ensure that genomic applications are responsibly and equitably adopted to benefit populations as well as individuals over time. Join TRANSPERS Director and member of the Roundtable Kathryn Phillips at this workshop! Zoom or in-person, no fee to register. REGISTER NOW!