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Illumina, Harvard Pilgrim Health Care Ink Risk-Sharing Deal for Whole-Genome Sequencing

NEW YORK – Illumina and Harvard Pilgrim Health Care announced on Tuesday a risk-sharing agreement that will make whole-genome sequencing (WGS) available to certain Harvard Pilgrim patients beginning Jan. 1, 2021.

Under the terms of the deal, Harvard Pilgrim will cover WGS, through its network of lab providers, for pediatric patients meeting specific criteria.

Illumina and Harvard Pilgrim will share the risk on genetic testing costs. "Illumina guarantees that Harvard Pilgrim's average genetic testing costs for these complex patients will not increase compared to the baseline," an Illumina spokesperson said in an email. "In fact, Illumina has significant skin in the game: if Harvard Pilgrim's average genetic testing cost increases compared to an agreed-upon baseline, Illumina will reimburse Harvard Pilgrim up to an agreed-upon cap." The baseline and cap amounts, among other financial details, were not disclosed.

Together, Harvard Pilgrim and Illumina will analyze the data, adjudicate the financials, and prepare a peer-reviewed study for publication evaluating how insurance coverage of WGS impacts patient care and healthcare costs.

"Harvard Pilgrim proudly continues to lead the way in agreements designed to promote access for our members to leading-edge precision medicine technology, while containing costs for consumers and employers," Harvard Pilgrim CMO Michael Sherman said in a statement. "Our members will be able to take advantage of this comprehensive technology, potentially saving themselves enormous frustration, heartache, and financial challenges. Moreover, Illumina gains the opportunity to demonstrate its value in a real-world setting through expanded use of WGS, while Harvard Pilgrim provides additional benefits but deters additional expenses that would otherwise increase costs for our members."

The agreement follows a 2018 value-based contract between Illumina and Harvard Pilgrim, where Harvard Pilgrim covered non-invasive prenatal testing for average-risk pregnancies while Illumina would reimburse costs if they exceeded a pre-determined baseline.

The new deal also comes on the heels of an Illumina partnership with Weill Cornell Medicine and New York-Presbyterian Hospital to provide thousands of consenting patients with clinical WGS. 

"WGS can dramatically reduce the time it takes to diagnose genetic conditions, which can improve patient outcomes, as well as economics," Ammar Qadan, Illumina VP of global market access, said in a statement.