More Efficient, Evidence-Based PA Process Could Benefit Genomic Testing

With more than 77,000 genetic tests available and new tests constantly coming to market, it can be difficult for payers and providers alike to keep track of not just what the products are but also how effective they can be. To make sure that beneficiaries are receiving appropriate testing, many payers have prior authorization (PA) in place. But as the process often can be burdensome for providers, a more evidence-based, streamlined approach to coverage could authorize necessary genomic testing with greater efficiency.

AHIP conducted a study from February through April 2022 on PA practices and received responses from 26 health plans with 122 million commercial covered lives. Along with specialty drugs, genetic testing was the only other treatment that respondents said was subject to PA 100% of the time.

© 2024 MMIT
Angela Maas

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. She also has written for Spotlight on Market Access since its 2017 launch. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at Hem Aware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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