Dr Kibum Kim on Precision Medicine in Managed Care

There has been dramatic growth in the number of labels relevant to precision medicine, but there remains a gap in the number available and what health plans actually cover, explained Kibum Kim, PhD, MSc, research assistant professor, University of Utah.

Where are we currently with precision medicine in managed care?

My colleagues and I had a chance to look for recent studies into the recent shift and coverage for the use of precision medicine. Unfortunately, our effort resulted in a couple of studies dated back to 2012, meaning that it is a bit hard to see the movement over the last 5 years from publicly available data. In this report, there was a couple of key messages to us. The first thing we have to know about this precision medicine and companion diagnostics is how dynamic this area is.

In 2009, we had only about 50 medication labels relevant to precision medicine or pharmacogenomics. As of September 2018, the number of labeled precision medicine was approximately 300, meaning that we have seen a dramatic growth of this individualized or subpopulation specific intervention over the last 10 years.

The dynamic of precision medicine looks very hard to be captured by individual managed care plans or payers. This is to say why a systematic effort to summarize the recent trends in precision medicine in the setting of managed care is hard to be done and not published over the last 5 years. The most recently available data say that even the most evidence-proven technology was actually covered by around or less than 50% of the healthcare plans. Taking the dynamic of precision medicine in to consideration, it is inferred that the gap between the number of labeled precision medicine technology and the number of the coverage decision has continued or has become larger, which is corresponding to what has discussed by multiple representatives of managed care.
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