Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.
Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.
Transcript (slightly modified)
What specific challenges does the molecular diagnostics industry face with respect to insurance coverage for their products?
So, I think that there is a challenge associated with getting coverage for molecular diagnostics. I think that for the most part payers have been slow to adopt new technologies and really, they haven’t been incentivized to do so, I think, up until recently. But I think what we’re starting to see is that payers are being more proactive, certainly, in seeking out companies like Foundation Medicine who are building these comprehensive genomic profiling assays to understand at the molecular level what’s going on inside a patient’s tumor, and these are encouraging signs.
I think that they’re starting to understand the implication of using these molecular diagnostics up front at the very point of diagnosis, because it can remove a lot of the ambiguity associated with following that trail of breadcrumbs about understanding what is really contributing to a patient’s disease and what is the best course of therapy. So rather than doing 1 test and getting 1 answer and then trying a treatment that doesn’t work and then trying another test, you do a comprehensive test like a FoundationOne test, for instance, up front, and it makes the healthcare process more efficient, and that’s a benefit to patients and payers.
Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
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