Jump to content

  • Set Your Location
  • Sign in or Enroll
Set Your LocationKahi Mohala
  • Sign in or Enroll
    • Open I want to choose my medical group or hospital
    • Clear my location
Change Location
Sutter Health
  • Video Visits
  • Find Doctors
  • Find Locations
  • Treatments & Services
    • Video Visits
    • Find Doctors
    • Find Locations
    • Treatments & Services
    • COVID-19 Resources
    • Pay a Bill
    • Symptom Checker
    • Get Care Today
    • Health & Wellness
    • Classes & Events
    • Research & Clinical Trials
    • For Patients
    • About Sutter Health
    • Giving
    • Volunteering
    • Careers
    • News
    • For Medical Professionals
    • Other Business Services
Close Search
  • Home
  • Kāhi Mōhala
  • Research
  • Health Policy
Content

Insights from a temporal assessment of increases in US private payer coverage of tumor sequencing from 2015 to 2019.

Description

Trosman JR, Douglas MP, Liang SY, Weldon CB, Kurian AW, Kelley RK, Phillips KA., Value Health. 23(5):551-558. doi: 10.1016/j.jval.2020.01.018. Epub 2020 Mar 19., 2020 May 01

Investigators

Su-Ying Liang, Ph.D., Research Economist / Faculty

Abstract

Objectives:  To examine the temporal trajectory of insurance coverage for next-generation tumor sequencing (sequencing) by private US payers, describe the characteristics of coverage adopters and nonadopters, and explore adoption trends relative to the Centers for Medicare and Medicaid Services' National Coverage Determination (CMS NCD) for sequencing.  

Methods:  We identified payers with positive coverage (adopters) or negative coverage (nonadopters) of sequencing on or before April 1, 2019, and abstracted their characteristics including size, membership in the BlueCross BlueShield Association, and whether they used a third-party policy. Using descriptive statistics, payer characteristics were compared between adopters and nonadopters and between pre-NCD and post-NCD adopters. An adoption timeline was constructed.  

Results:  Sixty-nine payers had a sequencing policy. Positive coverage started November 30, 2015, with 1 payer and increased to 33 (48%) as of April 1, 2019. Adopters were less likely to be BlueCross BlueShield members (P < .05) and more likely to use a third-party policy (P < .001). Fifty-eight percent of adopters were small payers. Among adopters, 52% initiated coverage pre-NCD over a 25-month period and 48% post-NCD over 17 months.  

Conclusions:  We found an increase, but continued variability, in coverage over 3.5 years. Temporal analyses revealed important trends: the possible contribution of the CMS NCD to a faster pace of coverage adoption, the interdependence in coverage timing among BlueCross BlueShield members, the impact of using a third-party policy on coverage timing, and the importance of small payers in early adoption. Our study is a step toward systematic temporal research of coverage for precision medicine, which will inform policy and affordability assessments. 

Pubmed Abstract

Pubmed AbstractOpens New Window

Associated Topics

  • Genetics
  • Health Policy

Related Publications

Commentary: It's more than just the price.


Health Serv Res. 2020 Aug;55(4):496-499. doi: 10.1111/1475-6773.13317.
2020 Aug 01

Disparities In outcomes among COVID-19 patients In a large health care system In California.

Azar KMJ, Shen Z, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR.
Health Aff (Millwood). 101377hlthaff202000598. doi: 10.1377/hlthaff.2020.00598. [Epub ahead of print]
2020 May 21

Assessment of accuracy and usability of a fee estimator for ambulatory care in an integrated health care delivery network.

Stults CD, Li J, Frosch DL, Krishnan H, Smith-McCurdy G, Jones VG, Chan AS.
JAMA Netw Open. 2(12):e1917445. doi: 10.1001/jamanetworkopen.2019.17445.
2019 Dec 02

Medication burden in patients with acute coronary syndromes.

Wright EA, Steinhubl SR, Jones JB, Barua P, Yan X, Van Loan R, Frederick G, Bhandary D, Cobden D.
Am J Manag Care. 2017 Apr 1;23(4):e106-e112.
2017 Apr 01

Lower copay and oral administration: predictors of first-fill adherence to new asthma prescriptions.

Berger Z, Kimbrough W, Gillespie C, Boscarino JA, Wood GC, Qian Z, Jones JB, Shah NR.
Am Health Drug Benefits. 2(4):174-80.
2009 Jun 01
The Sutter Health Network of Care
Expertise to fit your needs
Primary Care

Check-ups, screenings and sick visits for adults and children.

Specialty Care

Expertise and advanced technologies in all areas of medicine.

Emergency Care

For serious accidents, injuries and conditions that require immediate medical care.

Urgent Care

After-hours, weekend and holiday services.

Walk-In Care

Convenient walk-in care clinics for your non-urgent health needs.

  • Contact Us
  • Find Doctors
  • Find Locations
  • Request Medical Records
  • Make a Gift
Sign in to My Health Online

Billing and Insurance

  • Pay a Bill
  • Accepted Health Plans
  • Estimate Costs
  • Medicare Advantage

About Sutter

  • About Our Network
  • Community Benefit
  • Annual Report
  • News

Our Team

  • For Employees
  • For Medical Professionals
  • For Vendors
  • For Volunteers

Careers

  • Jobs at Sutter
  • Physician Jobs
  • Graduate Medical Education

Copyright © 2023 Sutter Health. All rights reserved. Sutter Health is a registered trademark of Sutter Health ®, Reg. U.S. Patent & Trademark office.

  • ADA Accessibility
  • Privacy
  • Do Not Sell My Personal Information
  • LinkedIn Opens new window
  • YouTube Opens new window
  • Facebook Opens new window
  • Twitter Opens new window
  • Instagram Opens new window
  • Glassdoor Opens new window

Cookie Policy

We use cookies to give you the best possible user experience. By continuing to use the site, you agree to the use of cookies. Privacy Policy Cookie Preferences

Privacy Policy Cookie Preferences