Payment for Cancer Biomarker Testing

Payment for Cancer Biomarker Testing


"At a time when payers, struggling to thrive in the current dynamic health care environment, must clearly understand the cost of patient care,3 they ‘‘are definitely on board with biomarker tests, particularly when it means that they are paying for drugs that patients will likely respond to—and conversely are not paying for several months of drugs or chemotherapy that will have little positive effect.’’ 8 But it has been difficult to ‘‘get a handle’’ on biomarker test payment because payment requirements evolve and change over time, payers approach payment in different ways for different technologies,9 and the majority of payers pay for diagnostic molecular tests separately from the associated therapy.10 In fact, payment for cancer biomarker tests may be a more difficult issue than payment for new oncology treatments themselves."