Personalized medicine: part 3: challenges facing health care plans in implementing coverage policies for pharmacogenomic and genetic testing.

摘要

Most health care payers recognize that personalized medicine (PM) and genetic testing will create important changes in clinical practice in the future. Insurers will need to determine which medical expenses to cover in their policies; which tests have clinical utility; which ones actually change the treatment choices for physicians; and which ones are more interesting to consumers but do not affect the clinical setting.Many questions are cropping up in the payer community, some coming from the media and some arising from people in the field of PM. Per Lofberg, Executive Vice President of CVS Caremark and President of Caremark Pharmacy Services, and his team spoke to many in the insurance industry as they traveled around the country. Almost without exception, these payers were poorly equipped to answer questions that Lof-berg's group asked. For example, for Medco Health Solutions, Inc., and other pharmacy benefit managers (PBMs), the natural evolution is to incorporate genetic testing, when shown to be valuable, into the prescription drug choices that physicians are making. PBMs are in the interesting position of being able to capture prescription data at an early stage; they have an opportunity to make suggestions to patients and physicians. In the future, the Lofberg team suggests, certain genetic tests will need to be performed before drug selection is finalized. It thus makes sense for PBMs to be in the forefront of this change in terms of pharmacogenomic testing in relation to drugs that they manage.