Thursday, December 24, 2015

Who will pay for personalized medicine?

Inventors have faced this problem for centuries: just because you can make it, does it mean anyone will pay for it? And just because its possible, doesn't mean anyone wants it. Unless you can put some guarantee of a good result on it.

Personalized and precision medicine has been the buzz for several years now. But who is going to pay for it? I have never seen this discussed previously. I sort of assumed that someone would but never thought the process through. And what happens if the test result isn't a good one?

I just know I wouldn't be happy to shell out a few thousand without the guarantee that the results would lead me to a life saving recommendation. And what if I did spend the big bucks and all the result told me was that there were no good treatment protocols for me? That would not leave me a very happy camper at all.

Back to personalized medicine... What if no one wants to pay for it? And is there a guarantee that the test results would lead to the right treatment? What if there is no good treatment protocol available?

Right now we get an ailment and start a treatment protocol. If it doesn't work, we go on to plan B, or C, or D.... all the way to plan Z. Personalized medicine is supposed to tell us skip plan A and go directly to plan L as that is right for you. But what if there is no plan L yet? Or plan L only has a 50% chance of working for you? And plans A, B and C had a 30% chance of working for you.

One test for patients with a certain type of lung cancer has now been approved for payment by one insurance company. That's a very small start. Medicare has not decided if they will pay or not.

"Medicare and private insurers have been slow to embrace genetic tests such as Foundation Medicine’s that look at a broad array of genes. (Other genetic tests, such as those that analyze specific genes known to increase a person’s risk of cancer, are more widely covered.) The payers are concerned that the tests could lead to care that won’t improve patient outcomes."
I am right there with the insurance companies (how unlike me) on this one. I want a treatment that will improve my outcome... That's the whole point of personalized medicine.

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