Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Payer coverage policies for multigene tests

Nature Biotechnology volume 35, pages 614–617 (2017)Cite this article

Subjects

To the Editor:

New technologies are enabling genetic tests that measure multiple rather than single genes. The availability of 'multigene tests' (panels and whole exome/genome sequencing tests) is rapidly growing, which raises critical questions about whether and how payers will cover them. Here, we survey the policies of the five largest US private payers that include multigene tests (including 55 policies that cover 313 multigene tests; Table 1, Supplementary Methods and Supplementary Table 1). Our findings reveal that most multigene tests are not covered by payers and that there is a high degree of variability as to how test coverage is assessed. We believe our analysis is the largest systematic review of US coverage policies for multigene tests to date. Efforts to obtain such data and carry out systematic analyses will be essential to increase the transparency and understanding of insurance coverage policies, a fundamental need for informed policy making.

Table 1 Multigene test policy coverage by payer
Full size table

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Kolata, G. & Harris, G. New York Times, p. A17 (13 January 2016).

  2. Phillips, K.A. J. Am. Med. Assoc. 300, 2542–2544 (2008).

    Article  CAS  Google Scholar 

  3. Hresko, A. & Haga, S.B. J. Pers. Med. 2, 201–216 (2012).

    Article  Google Scholar 

  4. Graf, M., Needham, D., Teed, N. & Brown, T. Per. Med. 10, 235–243 (2013).

    Article  CAS  Google Scholar 

  5. Clain, E., Trosman, J.R., Douglas, M.P., Weldon, C.B. & Phillips, K.A. Nat. Biotechnol. 33, 900–902 (2015).

    Article  CAS  Google Scholar 

  6. Dervan, A.P. et al. Genet. Med. 19, 559–567 (2016).

    Article  Google Scholar 

  7. Chambers, J. et al. Intl. J. Technol. Assess. Health Care (in press).

  8. Anonymous. AIS Health http://aishealth.com/health-plan-business/data/enrollment (2014; accessed 4 January 2017).

  9. Curnutte, M.A. et al. Nat. Biotechnol. 34, 466–470 (2016).

    Article  CAS  Google Scholar 

  10. Trosman, J.R., Weldon, C.B., Kelley, R.K. & Phillips, K.A. J. Natl. Compr. Canc. Netw. 13, 311–318 (2015).

    Article  Google Scholar 

  11. Trosman, J.R., Van Bebber, S.L. & Phillips, K.A. J. Oncol. Pract. 6, 238–242 (2010).

    Article  Google Scholar 

  12. Trosman, J.R., Van Bebber, S.L. & Phillips, K.A. J. Oncol. Pract. 7 Suppl, 18s–24s (2011).

    Article  Google Scholar 

  13. Deverka, P.A., Kaufman, D. & McGuire, A.L. J. Am. Med. Assoc. 312, 1857–1858 (2014).

    Article  CAS  Google Scholar 

  14. Anonymous. Genomeweb https://www.genomeweb.com/cancer/unitedhealthcare-covers-foundation-medicine-test-metastatic-lung-cancer (2015; accessed 4 January 2017).

  15. Anonymous. Genomeweb https://www.genomeweb.com/sequencing-technology/cigna-issues-coverage-criteria-whole-exome-sequencing-wgs-still-not-covered (2015; accessed 4 January 2017).

Download references

Acknowledgements

This work was supported by a grant to K.A.P. from the National Human Genome Research Institute (R01HG007063-S1). We are grateful to C. Liu (Albert Einstein School of Medicine) for coding help.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, California, USA

    Kathryn A Phillips, Julia R Trosman & Michael P Douglas

  2. Philip R. Lee Institute for Health Policy, University of California San Francisco, San Francisco, California, USA

    Kathryn A Phillips

  3. Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA

    Kathryn A Phillips

  4. American Institutes for Research, Chapel Hill, North Carolina, USA

    Patricia A Deverka

  5. University of North Carolina, Eshelman School of Pharmacy, Center for Pharmacogenomics and Individualized Therapy, Chapel Hill, North Carolina, USA

    Patricia A Deverka

  6. Center for Business Models in Healthcare, Chicago, Illinois, USA

    Julia R Trosman & Christine B Weldon

  7. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Julia R Trosman & Christine B Weldon

  8. The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies,

    James D Chambers

  9. Tufts Medical Center, Boston, Massachusetts, USA

    James D Chambers

  10. Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington, USA

    Andrew P Dervan

Authors
  1. Kathryn A Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia A Deverka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia R Trosman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael P Douglas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James D Chambers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christine B Weldon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew P Dervan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn A Phillips.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary Text and Figures

Supplementary Figure 1 and Supplementary Tables 1–3 (PDF 128 kb)

Supplementary Methods

Supplementary Methods (PDF 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phillips, K., Deverka, P., Trosman, J. et al. Payer coverage policies for multigene tests. Nat Biotechnol 35, 614–617 (2017). https://doi.org/10.1038/nbt.3912

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nbt.3912

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing