--- title: "US private payer coverage of tumor sequencing 2015-2019 | Sutter Health" description: "Our study is a step toward systematic temporal research of coverage for precision medicine, which will inform policy and affordability assessments." url: "https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. US private payer coverage of tumor sequencing 2015-2019 # Insights from a temporal assessment of increases in US private payer coverage of tumor sequencing from 2015 to 2019. 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._ 2020-05-01 ## 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](https://pubmed.ncbi.nlm.nih.gov/32389219/) ![Su-Ying Liang, Ph.D.](https://dyn.mktgcdn.com/p/cRIUee_GK3HEL1Wq8svqoUApvABjlwVVA-KUHVGzuNw/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Su-Ying Liang, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030) ## Research topics - [Genetics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Genetics%5C%22%22) - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Clopidogrel pharmacogenomics: next steps: a clinical algorithm, gene-gene interactions, and an elusive outcomes trial.](https://www.sutterhealth.org/research/publications/clopidogrel-pharmacogenomics-1055312893) Gladding P1, Panattoni L, Webster M, Cho L, Ellis S. JACC Cardiovasc Interv. 3(10):995-1000. doi: 10.1016/j.jcin.2010.08.012. 2010 Oct 01 - Publication ### [Capacity building for assessing new technologies: approaches to examining personalized medicine in practice.](https://www.sutterhealth.org/research/publications/capacity-building-for-assessing-new-technologies-1055312563) Van Bebber SL, Trosman JR, Liang SY, Wang G, Marshall DA, Knight S, Phillips KA. Per Med. 7(4):427-439 2010 Jul 01 - Publication ### [Medicare's policy not to pay for treating hospital-acquired conditions: the impact.](https://www.sutterhealth.org/research/publications/medicare-policy-on-hospital-acquired-conditions-1055312578) McNair PD, Luft HS, Bindman AB. Health Aff (Millwood). 28(5):1485-93. doi: 10.1377/hlthaff.28.5.1485. 2009 Oct 01 - Publication ### [Is good enough for our peers good enough for policy makers?](https://www.sutterhealth.org/research/publications/good-enough-for-policymakers-1055312319) Luft HS. Health Serv Res. doi: 10.1111/1475-6773.12750. \[Epub ahead of print\] 2017 Sep 04 - Publication ### [From small area variations to accountable care organizations: how health services research can inform policy](https://www.sutterhealth.org/research/publications/small-variations-to-accountable-care-organizations-1055312595) Luft HS. Annu Rev Public Health. 33:377-92. doi: 10.1146/annurev-publhealth-031811-124701. Epub 2012 Jan 3. 2012 Apr 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"US private payer coverage of tumor sequencing 2015-2019"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764#medicalscholarlyarticle","name":"Insights from a temporal assessment of increases in US private payer coverage of tumor sequencing from 2015 to 2019.","headline":"US private payer coverage of tumor sequencing 2015-2019","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 \u003c .05) and more likely to use a third-party policy (P \u003c .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.","description":"Our study is a step toward systematic temporal research of coverage for precision medicine, which will inform policy and affordability assessments.","keywords":["Genetics","Health Policy"],"datePublished":"2020-05-01","url":"https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"32389219"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1016/j.jval.2020.01.018"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/32389219/","https://doi.org/10.1016/j.jval.2020.01.018"],"isPartOf":{"@type":"Periodical","name":"Value Health"},"author":[{"@type":"Person","name":"Trosman JR"},{"@type":"Person","name":"Douglas MP"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030","name":"Liang SY","url":"https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030"},{"@type":"Person","name":"Weldon CB"},{"@type":"Person","name":"Kurian AW"},{"@type":"Person","name":"Kelley RK"},{"@type":"Person","name":"Phillips KA"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Genetics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Genetics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Policy","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Policy%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/us-private-payer-coverage-of-tumor-sequencing-2015-2019-1055312764#breadcrumblist"}}} ```