Currently Viewing:
The American Journal of Managed Care April 2018
Currently Reading
Delivering on the Value Proposition of Precision Medicine: The View From Healthcare Payers
Jane Null Kogan, PhD; Philip Empey, PharmD, PhD; Justin Kanter, MA; Donna J. Keyser, PhD, MBA; and William H. Shrank, MD, MSHS
Cost Sharing and Branded Antidepressant Initiation Among Patients Treated With Generics
Jason D. Buxbaum, MHSA; Michael E. Chernew, PhD; Machaon Bonafede, PhD; Anna Vlahiotis, MA; Deborah Walter, MPA; Lisa Mucha, PhD; and A. Mark Fendrick, MD
The Well-Being of Long-Term Cancer Survivors
Jeffrey Sullivan, MS; Julia Thornton Snider, PhD; Emma van Eijndhoven, MS, MA; Tony Okoro, PharmD, MPH; Katharine Batt, MD, MSc; and Thomas DeLeire, PhD
A Payer–Provider Partnership for Integrated Care of Patients Receiving Dialysis
Justin Kindy, FSA, MAAA; David Roer, MD; Robert Wanovich, PharmD; and Stephen McMurray, MD
Financial Burden of Healthcare Utilization in Consumer-Directed Health Plans
Xinke Zhang, PhD; Erin Trish, PhD; and Neeraj Sood, PhD
Progress of Diabetes Severity Associated With Severe Hypoglycemia in Taiwan
Edy Kornelius, MD; Yi-Sun Yang, MD; Shih-Chang Lo, MD; Chiung-Huei Peng, DDS, PhD; Yung-Rung Lai, PharmD; Jeng-Yuan Chiou, PhD; and Chien-Ning Huang, MD, PhD
Physician and Patient Tools to Improve Chronic Kidney Disease Care
Thomas D. Sequist, MD, MPH; Alison M. Holliday, MPH; E. John Orav, PhD; David W. Bates, MD, MSc; and Bradley M. Denker, MD
Limited Distribution Networks Stifle Competition in the Generic and Biosimilar Drug Industries
Laura Karas, MD, MPH; Kenneth M. Shermock, PharmD, PhD; Celia Proctor, PharmD, MBA; Mariana Socal, MD, PhD; and Gerard F. Anderson, PhD
Provider and Patient Burdens of Obtaining Oral Anticancer Medications
Daniel M. Geynisman, MD; Caitlin R. Meeker, MPH; Jamie L. Doyle, MPH; Elizabeth A. Handorf, PhD; Marijo Bilusic, MD, PhD; Elizabeth R. Plimack, MD, MS; and Yu-Ning Wong, MD, MSCE

Delivering on the Value Proposition of Precision Medicine: The View From Healthcare Payers

Jane Null Kogan, PhD; Philip Empey, PharmD, PhD; Justin Kanter, MA; Donna J. Keyser, PhD, MBA; and William H. Shrank, MD, MSHS
Genomics-based precision medicine has the potential to transform healthcare delivery. However, effective collaborations among scientists, clinicians, and payers are needed to accelerate the translation of precision medicine to clinical practice and ensure its sustainability.
Clearly, to increase the likelihood that precision medicine innovations will be both covered by payers and used appropriately in clinical practice, scientists and clinicians must provide better information about their comparative benefits, risks, and costs. However, for many reasons, they are poorly equipped to do this on their own or at an optimal pace. Collaboration with payers offers a unique opportunity to more rapidly develop the information required for evidence-based decision making. By linking genomic and clinical information with claims and cost data at the population level, conclusions can be drawn about the clinical and cost-effectiveness of genetic tests and targeted therapies in the domains and patient populations that are most important to payers. In fact, well-designed real-world observational studies or pragmatic clinical trials conducted in collaboration with payers could strengthen the evidence base for precision medicine by including head-to-head comparisons with the current standard of care, clinically meaningful outcomes and economic end points, and larger, more diverse patient populations that can be tracked over time.

Large projects, such as Vanderbilt University Medical Center’s PREDICT program, the US Department of Veterans Affairs’ Million Veterans Program, the collaboration partnering Renown Health and the Desert Research Institute with 23andMe, and Geisinger’s MyCode Community Health Initiative with the Regeneron Genetics Center, are now working to combine various sources of health, population, genetic, medication, and environmental data to support precision medicine innovations. For the most part, however, large payers have been reluctant to enter this space, as the incentives are better aligned for them to consume published evidence rather than to develop it.

At University of Pittsburgh Medical Center (UPMC), an integrated delivery and financing system in Pittsburgh, Pennsylvania, efforts are under way to demonstrate the value of genomic information for many of the health plan members enrolled in the University of Pittsburgh’s patient registry, Pitt+Me, and its linked precision medicine biobank. Specifically, we are developing processes to share and store data; implement clinical pathways around genomic tests and therapies, such as pharmacogenomics; deliver results at points of care; and support adoption of precision medicine within sustainable reimbursement models. UPMC is also a partner in other initiatives, such as the National Institutes of Health’s All of Us research program, which is designed to combine biological, lifestyle, healthcare, and environmental data on 1 million Americans.

Most people would agree that precision medicine is the future of healthcare. But the path can be direct or circuitous. Rather than continue to waste our precious resources or wait decades for important developments to be diffused, we propose to accelerate value creation by opening lines of communication with payers and strengthening collaboration for evidence generation.

Author Affiliations: UPMC Center for High-Value Health Care (JNK, JK, DJK), Pittsburgh, PA; Pitt/UPMC Institute for Precision Medicine, University of Pittsburgh (PE), Pittsburgh, PA; UPMC Insurance Services Division (WHS), Pittsburgh, PA.

Source of Funding: None.

Author Disclosures: Dr Kogan, Mr Kanter, Dr Keyser, and Dr Shrank are employed at UPMC. Dr Empey has received an unrelated educational investigator-initiated grant from 23andMe, a testing company.

Authorship Information: Concept and design (JNK, PE, JK, DJK, WHS);  drafting of the manuscript (JNK, PE, JK, DJK, WHS); critical revision of the manuscript for important intellectual content (DJK, WHS); administrative, technical, or logistic support (JNK, JK, DJK); and supervision (JNK). 

Address Correspondence to: Jane Null Kogan, PhD, UPMC Insurance Services Division, UPMC Center for High-Value Health Care, US Steel Tower, 600 Grant St, 40th Fl, Pittsburgh, PA 15219. Email:

1. Burns J. Health insurers struggle to manage number, cost of genetic tests. Manag Care. 2016;25(4):20-23.

2. UnitedHealth Group. Personalized Medicine: Trends and Prospects for the New Science of Genetic Testing and Molecular Diagnostics. Minnetonka, MN: UnitedHealth Center for Health Reform & Modernization; 2012. Published March 12, 2012. Accessed October 1, 2017.

3. Lotvin AM, Shrank WH, Singh SC, Falit BP, Brennan TA. Specialty medications: traditional and novel tools can address rising spending on these costly drugs. Health Aff (Millwood). 2014;33(10):1736-1744. doi: 10.1377/hlthaff.2014.0511.

4. Empey PE. Pharmacogenomics to achieve precision medicine.Am J Health Syst Pharm. 2016;73(23):1906-1907. doi: 10.2146/ajhp160682.

5. Pirmohamed M, Burnside G, Eriksson N, et al; EU-PACT Group. A randomized trial of genotype-guided dosing of warfarin. N Engl J Med. 2013;369(24):2294-2303. doi: 10.1056/NEJMoa1311386.

6. Mega JL, Close SL, Wiviott SD, et al. Cytochrome P-450 polymorphisms and response to clopidogrel. N Engl J Med. 2009;360(4):354-362. doi: 10.1056/NEJMoa0809171.

7. Jiang M, You JH. Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy. Expert Opin Pharmacother. 2015;16(5):771-779. doi: 10.1517/14656566.2015.1013028.
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!