Alignment of health plan coverage policies for somatic multigene panel testing with clinical guidelines in select solid tumors.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2022-05-01 Epub Date: 2022-02-04 DOI:10.2217/pme-2021-0174

William B Wong, Daniele Anina, Chia-Wei Lin, Devon V Adams

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引用次数: 3

Abstract

Aim: Commercial plan coverage policies for multigene panel tests may vary and could result in geographic variation in coverage due to the fragmented nature of the commercial insurance market. This study aimed to characterize the alignment of multigene panel tests coverage policies to that of clinical guidelines, overall and by state. Materials & methods: We reviewed NCCN Guidelines^® for four tumors. Public coverage policies were identified via web search. Payer policies included those with the largest or second largest number of commercial lives in each state. Policies were classified as 'more restrictive' or 'consistent' with the guidelines. Results: Of 38 plans/policies reviewed, 71% were classified as 'more restrictive' than the guidelines, with variation in the number of commercial lives by state. Among these, 52% restricted on panel size and 63% restricted in all or select tumors. Conclusion: Most coverage policies were more restrictive. Clinical guideline clarity and state policies may improve alignment to guidelines and geographic variations.

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选定实体瘤的躯体多基因面板检测与临床指南的健康计划覆盖政策的一致性

目的:由于商业保险市场的碎片化性质，多基因面板测试的商业计划承保政策可能会有所不同，并可能导致承保范围的地域差异。本研究旨在描述多基因面板测试覆盖政策与临床指南的一致性，总体上和按州划分。材料与方法:我们回顾了四种肿瘤的NCCN指南®。通过网络搜索确定公共保险政策。付款人政策包括每个州商业生命数量最多或第二多的政策。政策被分为“限制性更强”和“与指导方针一致”两类。结果:在审查的38项计划/政策中，71%被归类为“限制性更强”，各州的商业生命数量有所不同。其中，52%的人限制了面板大小，63%的人限制了全部或部分肿瘤。结论:多数保险政策限制性较强。临床指南的明确性和国家政策可以改善指南的一致性和地理差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.