Diagnostic Testing and Stem Cell Transplants in Multiple Myeloma: The Health Plan Approach

Steven Peskin, MD, MBA, FACP: [Regarding] the growing array of genetic tests and molecular diagnostics [available], [we are] definitely looking at this very carefully. We recognize that some of these tests have huge consequential positive significance in terms of how they shape therapy and [decisions regarding] which therapies are used or not used. Certainly, while there is the relevance of something like Oncotype DX, and decisions about whether or not adjuvant chemotherapy is needed or not in breast cancer, and the value thereof, others are of very questionable significance. So, the information may be of only, at this point, academic interest.

We’re mindful that a test should have some import. Certainly, if it’s testing that’s being done to gather data in a clinical repository or to advance science, that’s an issue of importance as well. In the clinical realm, we’re looking to see that biomarkers, molecular diagnostics, have some relevance and aren’t, in a sense, a distraction or information that is not of any clinical value or clinical significance. That’s a bit of the conundrum that we see as it relates to this relative explosion in the number of molecular diagnostics and genetic tests that might be ordered.

[When it comes to looking at] someone who is being recommended for a stem cell transplant, there would be a prior authorization [process]. [A stem cell transplant] would come into that construct of a very significant, high-cost service that would get some scrutiny in terms of the appropriateness. Does that patient fall into the set of criteria that have been established by the National Cancer Institute and other authoritative sources [as a suitable candidate] for stem cell transplant? Do they have some reasonable chance of survival? There will be some thoughtful medical review of stem cell transplant, and then the appropriate management afterward for use of drugs to stave off rejection, graft versus host disease, and the like.