Policy

Reimbursement

Background

If the health care system is to secure the full benefits of personalized medicine, it must provide full and fair reimbursement for new technologies, products and services, based on market principles to the greatest extent possible. The reimbursement system — both governmental and private payers — must have coverage and payment policies that support the timely adoption of new personalized medicine technologies, including both diagnostics and therapeutics.

Since 2004, PMC's call to action is to monitor, evaluate, and contribute to the debate to ensure that personalized medicine is properly integrated into reimbursement systems in the years ahead.

2017

CMS' Laboratory Date of Service Policy

2016

CMS' 2016 Preliminary Gapfill Payment Determinations

CMS' Part B Drug Payment Model Proposal

2015

CMS PAMA Payment System

Oncology Care Model at CMS

2014

Fair and Rational Payment for Molecular Diagnostic Tests

Reimbursement for Personalized Medicine Diagnostics

Centers for Medicare and Medicaid Services (CMS) Specialty Practitioner Payment Models

2013

Centers for Medicare and Medicaid Services (CMS) Molecular Diagnostics Gapfill Payment Amounts

Centers for Medicare and Medicaid Services (CMS) Guidance Regarding Coverage and Evidence Development

2011

PMC and Bridgehead International Issue Brief on European Reimbursement

2010

PMC and Boston Healthcare Issue Brief on Reimbursement in the U.S.

2006

PMC Payer Principles

2005

Secretary's Advisory Committee on Genetics, Health and Society: Reimbursement Report