Payer Perspective: Adapting to Precision Medicine in Cancer Care

Payer perspective regarding updates to coverage for comprehensive genomic profiling, becoming more widely used in oncology practice.

Bruce Feinberg, DO: Eugean, from a payer perspective, it takes me back to the argument we used to use in categorizing lymphomas, when it was all histology. We were going from good and bad, fast and slow. At some point, we got to over 70. There were always the lumpers and the splitters. The lumper said, “We just need to differentiate how they’re clinically different.” The splitters said, “No, there’s nuance. You need to have that nuance.” From a payer perspective, do they want the lump or the split? How important is the nuance? How are they responding to this increasing precision aspect, especially in the cancer arena?

Eugean Jiwanmall, MPH, MBA: That’s a very good example that you shared. Going back to what Kenna [Mills Shaw] and Mark [Kris] said before, I agree wholeheartedly about finding the evolutional precision medicine over time. Let me try to bounce off what Kenna said regarding the categorization. I think that will answer the question too. Generally speaking, it’s absolutely right diagnostic, in particular prognostic but also therapeutic biomarkers as well. With precision medicine, Mark correctly stated that there’s no official definition in either the industry or the clinical world. There are certain pillars of precision medicine. I’m going to touch on 1 from a health care management reimbursement peer perspective. I wouldn’t say it’s the 1 that companies are most interested in, but it’s a critical 1 and is objective about the outcomes.

Depending on how you categorize it, the nuances about which 1 to pick depend on that exact situation. When you’re looking at it from a population health perspective and what all individuals are responsible for, you’re coming to a salary and looking at an individual case. You have opportunities to decide the objective outcomes that you’re going to need. Precision medicine, no matter the nuance, should be able to assist with that if not pick a prime role in it. That depends on the situation, the biomarker world, and the testing world. That’s what the focus is a majority of the time.

Transcript edited for clarity.

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