New TRANSPERS Study Finds Variable Insurer Coverage of New Genetic Tests

There is great interest in new genetic tests that measure multiple genes at once - rather than single genes - to impact health care. The availability of these multigene tests (panels and whole exome/genome sequencing tests) is rapidly growing, which raises critical questions about whether and how payers will cover them. A newly published study by the University of California San Francisco Center for Translational and Policy Research on Personalized Medicine (TRANSPERS) in Nature Biotechnology (2017:35(7) 614-618) is the first systematic analysis of payer coverage policies for multigene tests. Using data from the TRANSPERS Payer Coverage Policy Registry©, we found that most multigene tests are not covered by payers and that there is a high degree of variability in test coverage.

Our findings have important policy implications. First, in order to have informed decision-making, there needs to be objective and transparent information on coverage policies. Second, registries and other types of structured reviews are needed that systematically summarize coverage policies using standard terms and methods, given that these policies are complex and thus difficult to assess without a structured database.

The UCSF TRANSPERS Payer Coverage Policy Registry© is unique in its focus on coverage policies of multigene tests, inclusion of a wide range of key factors that influence coverage, and objective analyses by a non-profit academic institution. It was developed with a team of collaborators from multiple institutions (UCSF, Tufts Medical Center, American Institutes for Research, and Center for Business Models in Healthcare), with funding from the National Human Genome Research Institute. Data for this study came from coverage policies as of June 2015 from the five largest US private payers. More information on the Registry can be found on the TRANSPERS Website.