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 extent possible. The unit cost of new products could be greater than the products they are replacing; yet these new products may offer superior results for a smaller pool of patients. 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.

Moreover, the issue of whether the government should encourage or subsidize - though targeted grant programs - the development of the infrastructure to permit the application of personalized medicine presents its own policy dilemma. For example, both medical education about genetics and information technology (IT) systems in health care institutions will need to be improved to permit the use of more complex pharmacogenomic data and more detailed and accurate health history data in research and in clinical practice.

Fair and Rational Medicare Payment for Molecular Diagnostic Tests

• Policy Position
• Policy Background

Comments on SACGHS Draft Report "Coverage and Reimbursement of Genetic Tests and Services"

• Policy Position