UCSF

TRANSPERS publication in JAMA lays out health policy agenda on new CMS coverage policy for sequencing tests in cancer patients

In a JAMA Viewpoint published today, TRANSPERS Director Kathryn Phillips addresses the question of: "Evolving Payer Coverage Policies on Genomic Sequencing Tests: Beginning of the End or End of the Beginning?"

Reimbursement has been cited as a key barrier to the adoption of precision medicine into clinical care. This issue has recently attracted attention with the March 2018 Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) on next generation sequencing tests (NGS) for patients with advanced cancer. This policy represents a step forward by addressing the vexing issue of coverage for these complex tests. However, Dr. Phillips notes that it is now critical to address the broader policy implications of this new coverage approach. The implications of the CMS policy are far-reaching. As one observer noted: “like it or not, CMS policy aims to change everything in next generation sequencing.”

It is now time to develop a health policy agenda to address the broader implications of this new policy approach and to facilitate the development of the evidence needed for appropriate, efficient, and equitable policies and implementation. The article lays out the following questions to be examined:

  1. Will the new policy provide appropriate and equitable access to testing?

  2. Will the new policy be an efficient use of resources?

  3. Will the new policy improve patient and societal outcomes?

In conclusion, new approaches to coverage for NGS tests are needed, and the CMS policy represents a step forward. However, it is only the beginning of what will be an ongoing discussion as the science evolves.

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