Table 2 Interest in and coverage of pediatric and prenatal exome sequencing by the payer cohort

From: Perspectives of US private payers on insurance coverage for pediatric and prenatal exome sequencing: Results of a study from the Program in Prenatal and Pediatric Genomic Sequencing (P3EGS)

 % of payers
Level of overall interest in ES, N = 14
  Pediatric ES
    High57% (8/14)
    Medium29% (4/14)
    Low14% (2/14)
 Prenatal ES
    High29% (4/14)
    Medium21% (3/14)
    Low50% (7/14)
Currently provide coverage (or recommend coverage if you are a nonpayer)? N = 14
   Pediatric ES71% (10/14)
   Prenatal ES0% (0/14)
Reasons for coverage of pediatric ES, N = 10
   Availability of interventions informed by ES70% (7/10)
   See value in ending “the diagnostic odyssey”30% (3/10)
Reasons for noncoverage of pediatric ES, N = 4
   Insufficient evidence of utility of ES vs. standard care75% (3/4)
   See no merit in any multigene testing, including ES25% (1/4)
Reasons for noncoverage of prenatal ES, N = 14
   No evidence of utility100% (14/14)
   See no merit of ES prenatally, vs. postnatallya79% (11/14)
   Skeptical about the ability to gather evidencea29% (3/14)
   See more harm than benefita14% (2/14)
  1. High interest: actively follow new studies, frequent internal review of coverage and/or new indications. Medium interest: occasional review of new studies, somewhat frequent review of coverage. Low interest: not following new studies, infrequent or no internal discussions of coverage and/or new indications.
  2. ES exome sequencing
  3. aNot mutually exclusive.