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MDx/CDx Focus: Medi-Cal Covering XDx's AlloMap; NextGxDx Helping Docs Assess Genetic Test Coverage


XDx's AlloMap Gains Medi-Cal Coverage

California's Medicaid program Medi-Cal is covering XDx's molecular test AlloMap, the company said this week.

In announcing coverage by Medi-Cal, XDx highlighted that AlloMap is now covered by more than 200 insurers in the US, and that more than 80 percent of the tests performed in 2012 were reimbursed by payors.

AlloMap is a multi-gene expression test that doctors can use in addition to standard clinical measures to determine whether heart transplant patients with stable allograft function are at low risk of rejecting their new hearts. Approximately 2,000 heart transplants are performed annually in the US, and recipients undergo endomyocardial biopsies years after transplantation to track their risk of rejecting the transplant.

By launching AlloMap, a non-invasive blood-based test, XDx is hoping that doctors can reduce the need to perform endomyocardial biopsies in some patients after a heart transplant. Endomyocardial biopsies are uncomfortable and can cause serious complications in some cases.

AlloMap gauges the expression of 20 genes, and was approved by the US Food and Drug Administration in 2008. The test has been commercially available in the US since 2005, and is performed by XDx in a CLIA-certified lab.

NextGxDx Adds 'Eligibility Check' Feature Through Eligible API

NextGxDx has inked a deal with Eligible API to provide its users with access to services that can help them figure out whether a particular genetic test would be covered by payors for a patient.

NextGxDx is a healthcare information technology firm that recently launched a free, online platform through which doctors can search for marketed genetic tests, compare tests between labs, order tests for patients, and receive results (PGx Reporter 10/17/2012). Eligible API, meanwhile, operates a platform that can help healthcare providers figure out coverage eligibility for products and interventions from more than 700 health insurance companies.

Through the partnership between the firms, healthcare providers ordering genetic tests through NextGxDx will be able to use an "Eligibility Check" feature to help determine whether a patient is covered for a particular genetic test.

“With the explosive growth in the number of genetic tests available, healthcare providers are facing significant challenges when it comes to researching appropriate tests, determining insurance coverage, and estimating how much those tests will cost their patients,” Mark Harris, CEO of NextGxDx, said in a statement. “Our research has shown that genetic counselors and labs spend an inordinate amount of time trying to determine insurance coverage of genetic testing for their patients."

By providing the services of Eligible API, NextGxDx is hoping to lessen some of this work for healthcare providers. NextGxDx estimates that the work performed by healthcare providers to determine genetic testing coverage eligibility costs $3 to $4 per claim.

NextGxDx said it will not charge its users for making Eligible API's services available through its platform.