by Jane Anderson
In a first-in-the-nation move, Blue Shield of California has
agreed to cover rapid and ultra-rapid Whole Genome Sequencing for critically
ill infants and children in intensive care who have unexplained medical
conditions. The agreement — which will use testing at Rady Children's Institute
for Genomic Medicine, a center of excellence in genetic testing — likely will
spur additional insurers to add coverage for this diagnostic technology,
observers say.
"I think the way the health plans are going to go about
implementing this is exactly what you're seeing in this case — they’re going to
pick a center of excellence," says Ashraf Shehata, KPMG national sector
leader for health care and life sciences. "I think they're going to put
some bumper guards around how they could go forward with these approvals. And I
think in addition to that, you're going to see their medical policies probably
begin to adapt a bit more to accept the outputs that are coming from these
types of tests."
The decision by Blue Shield of California is important and
"continues the trend we're seeing for other genetic tests where the
increased availability of evidence on clinical and economic outcomes leads to
changes in coverage policies," says Kathryn Phillips, Ph.D., professor of
health economics and health services research at the University of
California-San Francisco.
"As with other genetic tests, it will be important to
continue to examine the trade-offs between the benefits and costs associated
with testing and the impact of increased coverage on access to care, test
utilization and costs," Phillips tells AIS Health.
Kristin Ciriello Pothier, principal at KPMG, says that payers
already cover whole genome sequencing for oncology diagnostics. "As we
flip it over to newborn babies, it's the same technique, and with more speed
required, which the newest sequencing technologies can deliver," she says.
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