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.


CMS: Proposed Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancer

CMS: Interpretation of the National Coverage Determination for Next-Generation Sequencing for Medicare Beneficiaries With Advanced Cancer


CMS: International Pricing Index Model for Medicare Part B Drugs

CMS: Calendar Year 2019 Medicare Clinical Laboratory Fee Schedule Preliminary Determinations

HHS: Step Therapy for Part B Drugs in Medicare Advantage (MA)

Trump Administration/HHS: Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

CMS: Medicare Hospital Inpatient Prospective Payment System Proposed Rule for FY 2019

CMS: Medicare National Coverage Analysis for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancer

CMS: Coverage of Next Generation Sequencing for Medicare Beneficiaries with Advanced Cancer


CMS: Innovation Center New Direction

CMS' Laboratory Date of Service Policy


CMS' 2016 Preliminary Gapfill Payment Determinations

CMS' Part B Drug Payment Model Proposal


CMS PAMA Payment System

Oncology Care Model at CMS


Fair and Rational Payment for Molecular Diagnostic Tests

Reimbursement for Personalized Medicine Diagnostics

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


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


PMC and Bridgehead International Issue Brief on European Reimbursement


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


PMC Payer Principles


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