Utility Before Profitability: The Evolving Evidence Paradigm For Molecular Diagnostics
• By Danielle Pambianco, John Ridge, and Marc Samuels
The standards needed for reimbursement of molecular diagnostics are changing – especially with respect to genomics-based tests, with their potential impact on public health with respect to screening, prevention, and measuring response to treatment, as well as cost. As the complexity of the assay development and launch process has grown, so too has the emphasis on evidence and clinical effectiveness, as well as the importance of finding better ways to align test coding and reimbursement with clinical value. But a lack of coordination across agencies and commercial players makes an assessment of the impact of any changes on evidence demands problematic.
The standards needed for reimbursement of molecular diagnostics are changing – especially with respect to genomics-based tests. As the complexity of the assay development and launch process has grown, so too has the emphasis on evidence and clinical effectiveness, as well as the importance of finding better ways to align test coding and reimbursement with clinical value.
The demise of code-stacking is bringing issues of evidence and coverage into even sharper relief. Code-stacking grew out of attempts...
