Segment 3: The Trouble with Prognostic Tests

Payers differentiate between predictive and prognostic diagnostic tests, and one is definitely more useful than the other, according to John L. Fox, MD, MHA, of Priority Health, and Bryan Loy, MD, MBA, of Humana.

In the predictive space, payers are looking to see if a specific biomarker can be used to predict whether or not a drug will produce better outcomes in certain patient populations, and there is good evidence of clinical utility, according to Dr Fox.

He and Dr Loy agree, though, that having the evidence of an association between a test and an outcome isn’t enough because whether or not the information is being used correctly is often unstudied.

“Having the study doesn’t necessarily mean that we’re going to get the value out of those tests as a payer,” Dr Loy said. “Having a good test in the wrong hands or if the information never gets utilized, there is not value for us.”