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

IF 1.7 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Personalized medicine 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

摘要

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

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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来源期刊
Personalized medicine
Personalized medicine 医学-药学
CiteScore
3.30
自引率
4.30%
发文量
49
审稿时长
6-12 weeks
期刊介绍: Personalized Medicine (ISSN 1741-0541) translates recent genomic, genetic and proteomic advances into the clinical context. The journal provides an integrated forum for all players involved - academic and clinical researchers, pharmaceutical companies, regulatory authorities, healthcare management organizations, patient organizations and others in the healthcare community. Personalized Medicine assists these parties to shape thefuture of medicine by providing a platform for expert commentary and analysis. The journal addresses scientific, commercial and policy issues in the field of precision medicine and includes news and views, current awareness regarding new biomarkers, concise commentary and analysis, reports from the conference circuit and full review articles.
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