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Updated: Feb 5, 2026
11:15
Next Generation Sequencing for the Detection of Actionable Mutations in Solid and Liquid Tumors
Published on: September 20, 2016
25.1K
From the Past to the Present: Insurer Coverage Frameworks for Next-Generation Tumor Sequencing
Julia R Trosman1, Christine B Weldon1, William J Gradishar2
1Center for Business Models in Healthcare, Glencoe, IL, USA; Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Summary
Insurance coverage for next-generation tumor sequencing (NGTS) is challenging. Adapting coverage frameworks is crucial for assessing NGTS and future genomic innovations in precision medicine.
Area of Science:
- Genomic Medicine
- Health Services Research
- Health Economics
Background:
- Next-generation sequencing (NGS) offers significant potential for precision medicine, particularly in oncology through next-generation tumor sequencing (NGTS).
- Current insurance coverage frameworks struggle to accommodate the complexities and rapid advancements of technologies like NGTS.
- Addressing these coverage challenges is critical for realizing the full benefits of NGTS in guiding cancer therapies.
Observation:
- Payers face difficulties in evaluating NGTS due to its innovative nature.
- Medicare's recent decision to cover NGTS highlights the urgency of addressing coverage policies.
Findings:
- Existing coverage frameworks require adaptation to adequately assess NGTS.
- Three proposed adaptation approaches were analyzed, revealing innovations and remaining gaps.
- Medicare's National Coverage Determination for NGTS was compared against these approaches.
Implications:
- The US healthcare system's approach to NGTS coverage offers insights for international payers.
- Further framework adaptation is necessary for effective assessment of NGTS and future genomic technologies.
- Implications extend to private payers, other medical technologies, and clinical areas.
Keywords:
insurance coveragenext-generation sequencingprecision medicineprecision oncologyreimbursementtumor sequencingMore Related Videos
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