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payor coverage

Pricing for FoundationOne CDx, which received FDA approval and a proposed CMS national coverage determination yesterday, will be determined under PAMA.

The company discussed expectations for how its products will fare against rivals into next year based on recent data and coverage decisions, and on expected reimbursement changes.

The NGS-based test, which was approved by the FDA in June, will be now available to the insurers' members, who have non-small cell lung cancer, in four states.

Piper Jaffray analyst William Quirk said the pricing, which was much higher than expected, will help push CareDx toward profitability.

BUPA Global and other private health insurers have approved reimbursement for OncoDNA's test, which is intended to provide a complete genetic profile of a patient's tumor. 

The company said that more than 95 percent of eligible early-stage breast cancer patients can now have the test paid by insurance.

Payors say online, automated systems will bring standardization and efficiency to prior authorizations, but doctors and labs are uncertain about the impact on patient care.

During the quarter, the firm secured payor coverage for its tests with UnitedHealthcare, Premera Blue Cross, and Aetna. 

The program, called Genetic Testing Solution, went into effect July 1 among Anthem Blue Cross' fully-insured and self-insured members.

Interpace Diagnostics said that the test will now be covered for Cigna's roughly 15 million members nationwide.

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