The bar for providing evidence to secure coverage and reimbursement for new technologies is routinely being raised. As an example, laboratories can meet the evidence requirements of Evidence Street and still not meet those of Anthem BCBS, another BCBS Association member. The varying definitions of clinical utility among health plans and third party technology assessment providers require lab companies to conduct numerous studies and publish data in multiple peer reviewed publications with little to no assurance that they will successfully secure coverage. Further, this lack of coverage often results in challenges with physician adoption due to the financial burden placed on patients in the absence of coverage for high cost, molecular testing and the continuing increase in patients’ responsibilities associated with benefit plan design. This talk will provide suggestions to address these challenges for participating laboratory providers.
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