Access and Reimbursement for Cancer-Related Pharmacogenetic Tests and Medications

Authors

Ann Wu, Harvard Pilgrim Health Care Institute, Boston, MA
Kathleen Mazor, Meyers Primary Care Institute, Worcester, MA
Rachel Ceccarelli, Harvard Pilgrim Health Care Institute, Boston, MAFollow
Christine Lu, Harvard Pilgrim Health Care Institute, Boston, MAFollow

Publication Date

8-10-2017

Keywords

health care financing, insurance, premiums, dissemination and implementation of innovations

Abstract

Background: Genomic tests are the fastest growing sector of medicine and medical science, yet there is a dearth of research on access to cancer-related pharmacogenetic tests and medications. The objective of this study is to explore views of clinicians about access to pharmacogenetic tests using qualitative methods.

Methods: We conducted semi-structured interviews with a purposeful sample of clinicians who had prescribed medications that should be guided by pharmacogenetic testing. The purpose of the interviews was to explore knowledge of insurance cost-sharing for test, experienced or perceived barriers to access, and strategies used for managing costs. Interviews were recorded and transcribed verbatim. Using directed qualitative content analysis, two members of the research team performed iterative open coding of the transcripts. Each interview transcript was independently read and coded by two members of the study team.

Results: Ten interviews were conducted (8 oncologists, 1 nurse practitioner, 1 nurse). Of the 10 clinicians, 6 practiced in an academic hospital setting and 4 practiced in a community setting. Clinicians described logistical and insurance issues relating to ordering genetic tests and medications. They also reported that they ordered pharmacogenetic tests based on medical need with little communication about insurance with patients; they had few perceived and experienced barriers in access to tests but had limited awareness of coverage of tests. The process of ordering tests is variable. In comparison, clinicians were much more aware of financial and administrative barriers to access cancer therapies related to pharmacogenetic testing, including burdensome and lengthy insurance approval and reimbursement processes for both patients and providers and substantial out-of-pocket costs.

Conclusion: Currently, ordering pharmacogenetic tests is less complex than ordering cancer therapies, but this is likely to change in the near future as administrative barriers are introduced to manage volume. Better understanding of the implementation of pharmacogenetic tests into community and clinical settings will help inform future implementation strategies for other more complex genomic technologies to improve patient outcomes.

Recommended Citation

Wu A, Mazor K, Ceccarelli R, Lu C. Access and reimbursement for cancer-related pharmacogenetic tests and medications. J Patient Cent Res Rev. 2017;4:171-2.