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Aetna Issues Positive Coverage Decision for NanoString's Prosigna Breast Cancer Test

NEW YORK (GenomeWeb) – NanoString Technologies announced today that health insurer Aetna has added the Prosigna breast cancer test to its Tumor Markers Clinical Policy Bulletin, opening the door for test coverage.

The decision provides access to Prosigna for Aetna's 19 million insurance plan members. Prosigna is an in vitro diagnostic test that uses the PAM50 gene expression signature to assess prognosis and risk of disease recurrence for patients with specific types of hormone receptor-positive breast cancer.

Aetna's tumor markers list is a collection of serum biomarkers that the company considers medically necessary for their respective stated indications. Aetna noted on its website that inclusion on the list does not constitute a guarantee that the test would be covered for any particular member. "The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary," the company said.

 

"Aetna is one of the nation's largest health plans, and its decision to cover Prosigna is a clear sign of the expanded interest we are garnering from public and private payors alike," said Brad Gray, president and chief executive officer of NanoString, in a statement. "Our team at NanoString will continue to work with national and regional payors to ensure their patients have access to this vital test." 

Aetna's decision represents the latest coverage and reimbursement victory for NanoString. Since the start of the year, the Seattle-based firm has received positive coverage decisions for Prosigna from Medicare contractors Noridian and Novitas. And in April, the French national healthcare system decided to cover the test.

Gray estimated that 125 million people in the US are covered for the Prosigna test. 

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