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Forward-Thinking Insurers Adopt Genomics, Medicare Makes Perilous, Costly Leap Backwards

Ellen Matloff, MS; Danielle Bonadies, MS; Meagan Farmer, MS
Authors from My Gene Counsel discuss gaps in CMS reimbursement policy for genetic testing and counseling, in light of advances in guidelines from groups that include the National Comprehensive Cancer Network. This commentary will appear in the upcoming issue of Evidence-Based Oncology™.
Genetic counselors and providers can also be part of the solution by being proactive, positive, and collaborative.  Genetics is moving too quickly for payers to be up-to-date on best practices.  These payers are not in the field seeing patients and often do not see or understand the gaps that their policies are creating.  They are not genetics experts and need relationships with professional societies, such as the National Society of Genetic Counselors, the American Society of Human Genetics, and  the American College of Medical Genetics to provide fast and efficient guidance.  These societies would be wise to create small internal committees of genetics providers with expertise in payer relations and to then reach out to each payer – including CMS – to offer their services in reviewing policies and providing guidance around them.  We should offer to speak at payer meetings and develop relationships with decision-makers within these plans.  In order to take advantage of the promise of genomics and precision medicine, insurers and genetics experts must be willing to work together to create policies that are effective, efficient, and fair to all parties involved.

Disclosures: Authors are stakeholders in My Gene Counsel, LLC, a privately owned company.

Editor’s Note: This commentary will appear in the August issue of Evidence-Based Oncology™.

References

 
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