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Health Plans

The Growing Need to Manage Genetic Testing and Molecular Diagnostics

The Growing Need to Manage Genetic Testing and Molecular Diagnostics

Genetic discovery is driving increased use of genetic tests and greater complexity of test selection. G2 Intelligence estimated that the market was $14.3B in 2010 and growing rapidly at 16% per year¹, and the Food and Drug Administration (FDA) states that more than 100 medications have pharmacogenomic information included in their drug labels².  Given the wealth of new information and the need to stay ahead of this curve, it’s often challenging to navigate the complexities of genetic testing options and their appropriate use.

Additionally, a national payor has experienced that approximately 20% of genetic tests are ordered inappropriately^3,4 resulting in unnecessary and avoidable costs. As a result of this growth and the demand for genetic tests by physicians and consumers, health plans face growing utilization of genetic tests often with only limited data to provide insight into whether a test is clinically useful or appropriate.

Reducing Inappropriate Testing and Lowering Costs

DNA Direct, the first genomic medicine organization to achieve comprehensive URAC-accreditation for health utilization management, offers several solutions for health plans to reduce inappropriate testing and lower costs. These solutions:

• Enable rapid assessment and policy development for existing and new genetic testing technologies
• Reduce inappropriate test selection
• Offer insight into utilization
• Help establish benchmarks, coverage policies, coverage criteria, and lab reimbursement parameters
• Provide education and outreach to physicians to help guide test decisions 

 The programs offered include:

• Policy and Benefit Support
• Coverage Management
• Decision Support

Contact us to learn how DNA Direct can help your health plan lower costs today.

1. G2 Intelligence: Lab Industry Strategic Outlook 2011: Market Trends & Analysis
2. www.fda.gov/drugs/scienceresearch/researchareas/pharmacogenetics/ucm083378.htm
3. World Research Group Conference presentation - April 2011: The Impact of Comprehensive Management of Molecular Diagnostics The Experience of Humana's Genetic Guidance Program
4. Analysis of insurance preauthorization requests for BRCA1 and BRCA2 genetic testing: experience of the Humana Genetic Guidance Program; Personalized Medicine (2011) 8(5), 563-569