Payer Medical Policies Can Promote Effective Use of Comprehensive Sequencing In Community Oncology Setting

Comprehensive genomic profiling (CGP) identifies clinically relevant genomic alterations that can be used to inform treatment decisions in community-based oncology practices that benefit both patients and payers, according to a study published in the Journal of Managed Care & Specialty Pharmacy. The authors say this real-world evidence supports covering CGP and integrating it into clinical practice. “Given the recently released Centers for Medicare & Medicaid Services National Coverage Decision for next-generation sequencing in patients with advanced cancer (which includes coverage for tests used in this observational analysis…), this observational analysis provides timely evidence of the utility of CGP in a real-world setting,” write the authors led by Mitchell Reitsma, from Priority Health in Grand Rapids, Mich. “The results presented here may provide insight into the clinical utility of broad CGP coverage for a commercial payer whose policy is in alignment with Medicare coverage of CGP in patients with advanced cancer.” CGP uses next-generation sequencing to detect genomic alterations, plus microsatellite instabilities and tumor mutational burden in order to guide treatment with targeted therapies. Despite emerging data demonstrating improved outcomes with targeted therapies, payers have been reluctant to cover CGP due to concerns about off-label drug use, test cost, and lack […]