By Jane Anderson
In a first-in-the-nation move, Blue Shield of California has agreed to cover rapid and ultra-rapid Whole Genome Sequencing for critically ill infants and children in intensive care who have unexplained medical conditions. The agreement — which will use testing at Rady Children’s Institute for Genomic Medicine, a center of excellence in genetic testing — likely will spur additional insurers to add coverage for this diagnostic technology, observers say.
“I think the way the health plans are going to go about implementing this is exactly what you’re seeing in this case — they’re going to pick a center of excellence,” says Ashraf Shehata, KPMG national sector leader for health care and life sciences. “I think they’re going to put some bumper guards around how they could go forward with these approvals. And I think in addition to that, you’re going to see their medical policies probably begin to adapt a bit more to accept the outputs that are coming from these types of tests.”
The decision by Blue Shield of California is important and “continues the trend we’re seeing for other genetic tests where the increased availability of evidence on clinical and economic outcomes leads to changes in coverage policies,” says Kathryn Phillips, Ph.D., professor of health economics and health services research at the University of California-San Francisco.
“As with other genetic tests, it will be important to continue to examine the trade-offs between the benefits and costs associated with testing and the impact of increased coverage on access to care, test utilization and costs,” Phillips tells AIS Health.
Kristin Ciriello Pothier, principal at KPMG, says that payers already cover whole genome sequencing for oncology diagnostics. “As we flip it over to newborn babies, it’s the same technique, and with more speed required, which the newest sequencing technologies can deliver,” she says.