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Cautious Interest Leads to Uncertainty

Though personalized medicine is generating a fair bit of noise, Stat News' Andrew Joseph writes that insurers are a bit wary of genetic tests that examine a range of genes.

"There's no consensus regarding, when you're looking at a tumor, how many genes you sequence and which ones you sequence," Kathryn Phillips, director of the Center for Translational and Policy Research on Personalized Medicine at the University of California, San Francisco, tells him. "More information is not always better — that's the payers' concern."

As GenomeWeb has reported, some private insurers are coming around. Foundation Medicine has announced that UnitedHealthcare will cover the firm's FoundationOne genomic profiling assay for patients with metastatic stage IV non-small cell lung cancer.

However, Joseph notes there is not a national policy regarding Medicare coverage of tests like Foundation Medicine's, though regional groups have recommended their use. Currently, Foundation Medicine isn't being reimbursed for tests it runs on Medicare patients.

This, Foundation Medicine CEO Michael Pellini tells Joseph, leads to a lot of uncertainty for companies in their space. "We simply have to shoot in the dark and hope that one of the bullets hit the bull's-eye," Pellini says.

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