Private payer coverage policies for exome sequencing (ES) in pediatric patients: trends over time and analysis of evidence cited.

ABSTRACT:

Purpose

Exome sequencing (ES) is being adopted for neurodevelopmental disorders in pediatric patients. However, little is known about current coverage policies or the evidence cited supporting these policies. Our study is the first in-depth review of private payer ES coverage policies for pediatric patients with neurodevelopmental disorders.

Methods

We reviewed private payer coverage policies and examined evidence cited in the policies of the 15 largest payers in 2017, and trends in coverage policies and evidence cited (2015-2017) for the five largest payers.

Results

There were four relevant policies (N = 5 payers) in 2015 and 13 policies (N = 15 payers) in 2017. In 2015, no payer covered ES, but by 2017, three payers from the original registry payers did. In 2017, 8

SUBMITTER: Douglas MP 

PROVIDER: S-EPMC6329652 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature