Influence of payer coverage and out-of-pocket costs on ordering of NGS panel tests for hereditary cancer in diverse settings.

Autor: Lin GA; Department of Medicine, University of California, San Francisco, CA, USA.; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.; Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA., Trosman JR; Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.; Center for Business Models in Healthcare, Glencoe, IL, USA., Douglas MP; Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA., Weldon CB; Center for Business Models in Healthcare, Glencoe, IL, USA., Scheuner MT; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.; Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA., Kurian A; Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA., Phillips KA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.; Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: Journal of genetic counseling [J Genet Couns] 2022 Feb; Vol. 31 (1), pp. 130-139. Date of Electronic Publication: 2021 Jul 07.
DOI: 10.1002/jgc4.1459
Abstrakt: The landscape of payment for genetic testing has been changing, with an increase in the number of laboratories offering testing, larger panel offerings, and lower prices. To determine the influence of payer coverage and out-of-pocket costs on the ordering of NGS panel tests for hereditary cancer in diverse settings, we conducted semi-structured interviews with providers who conduct genetic counseling and order next-generation sequencing (NGS) panels purposefully recruited from 11 safety-net clinics and academic medical centers (AMCs) in California and North Carolina, states with diverse populations and divergent Medicaid expansion policies. Thematic analysis was done to identify themes related to the impact of reimbursement and out-of-pocket expenses on test ordering. Specific focus was put on differences between settings. Respondents from both safety-net clinics and AMCs reported that they are increasingly ordering panels instead of single-gene tests, and tests were ordered primarily from a few commercial laboratories. Surprisingly, safety-net clinics reported few barriers to testing related to cost, largely due to laboratory assistance with prior authorization requests and patient payment assistance programs that result in little to no patient out-of-pocket expenses. AMCs reported greater challenges navigating insurance issues, particularly prior authorization. Both groups cited non-coverage of genetic counseling as a major barrier to testing. Difficulty of access to cascade testing, particularly for family members that do not live in the United States, was also of concern. Long-term sustainability of laboratory payment assistance programs was a major concern; safety-net clinics were particularly concerned about access to testing without such programs. There were few differences between states. In conclusion, the use of laboratories with payment assistance programs reduces barriers to NGS panel testing among diverse populations. Such programs represent a major change to the financing and affordability of genetic testing. However, access to genetic counseling is a barrier and must be addressed to ensure equity in testing.
(© 2021 National Society of Genetic Counselors.)
Databáze: MEDLINE
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