Payer Perspectives On Preemptive Pharmacogenetic Testing
Purpose: As preemptive pharmacogenetics expands in the academic healthcare setting, further study is needed to assess the views of additional stakeholders in the marketplace on this technology and the barriers and facilitators to their uptake. The purpose of this study is to investigate the perspectives and opinions about coverage policies for preemptive pharmacogenetic testing of third-party payers. Methods: A qualitative study utilizing a blended inductive and directed approach was conducted. A screener survey determined interview eligibility as well as demographic data. Semi-structured interviews were conducted with payers from organizations of varying structure and beneficiary populations. Meaning units and codes were used for each interview and aggregated to identify the subthemes and major themes. Results: A total of 14 payers were interviewed, covering 122,000,000 million lives, or almost 40% of the U.S. population. Positive and negative opinions were noted. Most positive opinions were prefaced with a position that pharmacogenetics held great potential for the healthcare system, but that full implementation was several years away. The work of the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Research Network (PGRN) was viefavorably. However, this would not drive policy decisions. Negative opinions came from a concern of the lack of data that would make these tests actionable for a payer from a policy development point of view. Concerns about the cost of testing large numbers of people was mentioned frequently, as well as the inability to predict when a patient or physician would use the data from a test or potential cost savings from the technology. Discussion: Preemptive pharmacogenetic testing remains a cautious pursuit for many payers. Lacking clinical outcomes data, the inability to evaluate the economic benefits from testing, and high costs are a few central concerns. Real-world implementations from academic institutions and the work of CPIC were seen as promising endeavors. The research community of pharmacogenetic advocates should review this study and focus their efforts on providing the data needed to guide informed policy decision making with regard to pharmacogenetic testing.
Payer, Pharmacogenetics, Policy, Genetics and Genomics
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