AMA Calls for More Consistent Genetic Test Coverage Determinations

11/21/17

Pointing to the potential usefulness of genetic tests and therapeutics in patient care, the American Medical Association (AMA) is calling for greater transparency and more standardized guidelines for payer coverage.

“Precision medicine tests, technologies, and therapeutics are increasingly being adopted into clinical practice as evidence of their effectiveness grows,” said William E. Kobler, MD, who serves on the association’s board, in an AMA press release (November 14, 2017). “However, many patients do not have access to precision medicine because most public and private health insurers do not offer coverage for genetic or genomic services unless certain clinical criteria and evidentiary standards are met. As a result, access to this next generation of clinical testing services is often limited.”

Noting considerable variability among payers regarding evidentiary requirements for coverage of genetic tests and services, physicians at the interim meeting of the AMA House of Delegates adopted a policy to encourage public and private payers to develop more consistent strategies.

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Specifically, the association is encouraging payers to adopt processes and methodologies for determining coverage of genetic/genomic precision medicine that:

  • ·      promote transparency and clarity;
  • ·      involve multidisciplinary stakeholders, including genetic/genomic medicine experts and relevant national medical specialty societies;
  • ·      describe the evidence being considered and methods for updating the evidence;
  • ·      provide opportunities for comment and review, as well as meaningful reconsiderations; and
  • ·      incorporate value assessments that consider the value of genetic/genomic tests and therapeutics to patients, families and society as a whole, including the impact on quality of life and survival

Jolynn Tumolo