ArticleJournal of the National Comprehensive Cancer Network : JNCCN2015
Challenges of coverage policy development for next-generation tumor sequencing panels: experts and payers weigh in.
Article in Journal of the National Comprehensive Cancer Network : JNCCN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers and facilitators to next-generation sequencing use in United States oncology settings: a systematic review.Future oncology (London, England) · 2024Pooled it
- Patient and Provider Experiences With Precision Oncology: Qualitative Descriptive Study at the Department of Veterans Affairs.JMIR cancer · 2026Article
- Implementation of Cancer Genomics in the United States: Views of Payers and Other Stakeholders on Challenges and the Role of Payers in Solutions.JCO precision oncology · 2025Article
- Impact of next-generation sequencing vs polymerase chain reaction testing on payer costs and clinical outcomes throughout the treatment journeys of patients with metastatic non-small cell lung cancer.Journal of managed care & specialty pharmacy · 2024Article
- Real-world clinical and economic outcomes for patients with advanced non-small cell lung cancer enrolled in a clinical trial following comprehensive genomic profiling via liquid biopsy.Journal of managed care & specialty pharmacy · 2024Article
- Perspectives of private payers on multicancer early-detection tests: informing research, implementation, and policy.Health affairs scholar · 2023Article
- Effective and Efficient Delivery of Genome-Based Testing-What Conditions Are Necessary for Health System Readiness?Healthcare (Basel, Switzerland) · 2022Article
- Emerging genetic biomarkers in lung adenocarcinoma.SAGE open medicine · 2022Review
- Outcomes of prior authorization requests for genetic testing in outpatient pediatric genetics clinics.Genetics in medicine : official journal of the American College of Medical Genetics · 2021Article
- Article
- The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations.Journal of clinical medicine · 2020Review
- Private Payer and Medicare Coverage for Circulating Tumor DNA Testing: A Historical Analysis of Coverage Policies From 2015 to 2019.Journal of the National Comprehensive Cancer Network : JNCCN · 2020Article
- Insights From a Temporal Assessment of Increases in US Private Payer Coverage of Tumor Sequencing From 2015 to 2019.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2020Article
- From the Past to the Present: Insurer Coverage Frameworks for Next-Generation Tumor Sequencing.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2018Article
- Precision Oncology Decision Support: Current Approaches and Strategies for the Future.Clinical cancer research : an official journal of the American Association for Cancer Research · 2018Review
- Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer.Journal of personalized medicine · 2018Article
- Value-based genomics.Oncotarget · 2018Review
- New Medicare Coverage Policy for Next-Generation Tumor Sequencing: A Key Shift in Coverage Criteria With Broad Implications Beyond Medicare.JCO precision oncology · 2018Article
- Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research.Genetics in medicine : official journal of the American College of Medical Genetics · 2017Review
- Payer coverage policies for multigene tests.Nature biotechnology · 2017Article
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Authors and funding
4 authors.
Funding
Abstract
backgroundNext-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers.
methodsWe conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings.
resultsAll interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies.
conclusionsPayers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement.
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