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U.S. insurers reluctant to cover genetic tests

In 2004, a feature article on this site addressed developments in genetic medicine. One of the items covered in that article was a new type of diagnostic test device called the Roche Diagnostic AmpliChip CYP 450, which analyses variations in two genes that play a major role in the metabolism of many widely prescribed drugs.

Now, just over two years since that article, Emily Singer of MIT’s Technology Review has written about her experiences in attempting to have an AmpliChip test in the U.S. From her article, it appears that there is a slow rate of uptake on genetic tests like this, not least because health insurance companies are reluctant to cover them.

This issue of health insurers tardiness regarding genetic medicine has also been referred to in a recent report by the Personalized Medicine Coalition, (PMC) a U.S. interest group for companies and academics involved in this sector. The PMC quotes Arthur Holden, Senior Vice President, Corporate Development of Illumina, Inc. (which develops tools for the large-scale analysis of genetic variation and function) as saying: “It is becoming increasingly important that insurers begin to engage to understand personalized medicine and evolve their payment models to reflect the value of such innovation. Currently, Medicare reimbursement policy for diagnostic tests is based on traditional methods of diagnosis through existing signs and symptoms rather than adopting molecular-based tests. These new molecular assays will support the personalization of healthcare to become both more proactive and more efficient.”

It should be pointed out that there is little evidence to suggest any discernable gap between the United States and Europe regarding the take-up for this type of testing.

The Technology Review article also points out that genetic testing did not exist when many current doctors were being trained, and they are more inclined to stick with tried-and-trusted methods. Indeed, when she does eventually succeed in getting an AmpliChip test carried out, the results tend to reinforce the viewpoint that such testing is not the complete solution to determining possible side-effects of medicines.

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