Opinion
Video
Kimberly C. Chen, DO, MSHLM, dives into the role of genetic testing in identifying patients eligible for gene therapy and explores coverage criteria, clinical validity, and utility considerations crucial for payers and managed care executives.
This is a video synopsis/summary of a Peer Exchange involving Ryan Haumschild, PharmD, MS, MBA; Jessica Nance, MD, MS; Kimberly C. Chen, DO, MSHLM; Emma Ciafaloni, MD, FAAN; and Mary Pak, MD, FACP.
In this discussion led by Haumschild, the focus shifts to the pivotal role of genetic testing in facilitating precision medicine, particularly in identifying candidates for gene therapy. Chen emphasizes the importance of tests demonstrating clinical validity and utility to warrant insurance coverage. Criteria such as compendia support, clinical guidelines, and outcomes-based clinical utility influence reimbursement decisions. Chen elaborates on insurance coverage nuances based on test purpose, payer type, and legislative mandates, highlighting the complexity of reimbursement determinations across different insurance plans. Haumschild underscores the significance of data dissemination by key opinion leaders to support coverage decisions, emphasizing the need for evidence-based approaches in patient population stratification. Chen affirms the role of payers in evaluating test utility and appropriateness for commercial coverage, emphasizing the need for alignment with clinical guidelines and actionable outcomes. The dialogue underscores the intricate balance between clinical innovation, evidence-based practice, and reimbursement considerations in advancing precision medicine initiatives.
Video synopsis is AI-generated and reviewed by AJMC® editorial staff.
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