NEW YORK (GenomeWeb) – Genetic Technologies, a molecular diagnostics firm manufacturing the BrevaGenplus breast cancer risk assessment test, today announced changes to its pricing and billing structure.
The Melbourne, Australia-based company is switching from a traditional reimbursement system through insurance providers to a direct patient self-pay program, it said in a statement, due to the fact that "gaining adequate payment for BrevaGenplus has become increasingly difficult over the last few years using a traditional payment model" through a Current Procedural Terminology (CPT) miscellaneous code.
The BrevaGenplus test is for women aged 35 years or older who have not had breast cancer but who have one or more risk factors, and is designed help make informed decisions about breast cancer screening and preventive treatment plans.
Under the patient self-pay program, BrevaGenplus will have a per test list price of $349, in line with what the company currently receives on a per test basis, compared to the $2,795 which is currently presented to medical insurance providers. The firm noted that insurers generally pay a price much lower than list price, but patients, when confronted with the balance six to nine months after a test, "can understandably become contentious."
"The primary issue is that current regulations [and] laws leave patients with minimum, if any, definition on how much they will be required to pay out of pocket for BrevaGenplus. Ultimately, this lack of fundamental transparency often demotivates patients' and physicians' interest in BrevaGenplus and furthermore, makes the collection of monies for services rendered more difficult," the firm said.
A customer-pay relationship, on the other hand, "dramatically simplifies the cost side of the equation for patients and makes it easy for physicians and their staff to answer questions regarding cost before sample collection," Genetic Technologies' CEO Eutillio Buccilli said.
"We have been monitoring the issue of payment for a considerable period of time and have observed how other MDx companies have approached the issue and which ones have been successful in transitioning to a different collection methodology. We are confident that now is the appropriate time to make this change," added Buccilli.
The new billing model can also be applicable to the Genetic Technologies' colorectal cancer risk assessment test, which is in the latter stages of development, the firm said.