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Viewpoint |

Overcoming the Reimbursement Barriers for Clinical Sequencing

Patricia A. Deverka, MD, MS1; David Kaufman, PhD2; Amy L. McGuire, JD, PhD3
[+] Author Affiliations
1Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
2Genetics and Public Policy Center, Johns Hopkins University, Washington, DC
3Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
JAMA. 2014;312(18):1857-1858. doi:10.1001/jama.2014.14915.
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This Viewpoint discusses an approach to reimbursement and coding challenges posed by next-generation genomic sequencing techniques.

Genomic tests using next-generation sequencing (NGS) technologies are increasingly being offered in a range of clinical settings. However, tests based on NGS may only transform clinical practice if patients and clinicians have access to them. This requires both favorable coverage decisions by public and private payers (eg, Medicare, Medicaid, commercial insurers) and adequate reimbursement levels to reward the development of innovative tests. Given that the hallmark of NGS technologies is the production of large amounts of data that require a bioinformatics infrastructure, sophisticated computational tools, and professional interpretation of the results, the current reimbursement and coding environment is not structured to necessarily recognize the value of NGS tests.

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