Personalized Medicine's Bottleneck: Diagnostic Test Evidence and Reimbursement.

ABSTRACT:

Background

Personalized medicine is gradually emerging as a transformative field. Thus far, seven co-developed drug-diagnostic combinations have been approved and several dozen post-hoc drug-diagnostic combinations (diagnostic approved after the drug). However, barriers remain, particularly with respect to reimbursement. Purpose, methods: This study analyzes barriers facing uptake of drug-diagnostic combinations. We examine Medicare reimbursement in the U.S. of 10 drug-diagnostic combinations on the basis of a formulary review and a survey.

Findings

We found that payers reimburse all 10 drugs, but with variable and relatively high patient co-insurance, as well as imposition of formulary restrictions. Payer reimbursement of companion diagnostics is limited and highly variable

SUBMITTER: Cohen JP 

PROVIDER: S-EPMC4263971 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature