In response to the sky-rocketing expenses associated with genetic and molecular testing, health insurers are planning ways to control both utilization and the prices at which these tests are reimbursed. For example, during the past year, Humana began using DNA Direct of San Francisco, California, to pre-authorize expensive genetic and molecular tests, while also advising physicians and counseling patients on their appropriate use. Pre-authorization of genetic testing may be the next big thing in medicine. On February 5, Medco Health Solutions acquired DNA Direct. Medco is one of the nation’s largest pharmacy benefits managers (PBMs). Medco stated that it wanted to integrate DNA Direct’s “physician, client, and patient support services” in genetic and molecular testing with its “growing portfolio of personalized medicine capabilities.”
ADD TO: GENETIC & MOLECULAR TESTS
More payers are requiring pre-authorization of genetic and molecular tests. Clinical laboratories and pathology groups should be responding to this trend to protect their access to patients and maintain their ability to provide these tests. Michael Snyder, President of Laboratory Management Services, LLC, says this will be one of the most significant changes in managed care contracts between payers and laboratories during 2010. He will provide information on this trend, along with effective strategies at the upcoming Executive War College on April 27-28, 2010, in New Orleans.
In reporting the changes and the new equity owners at Pathology, Inc., of Torrance, California, in the January 25, 2010, issue of THE DARK REPORT, the role of England & Company was not properly credited. England & Company acted as the exclusive adviser to the investor group, which included ABS Capital and ORIX Venture Finance LLC.
- Philip Chen, M.D., Ph.D., resigned from Sonic Healthcare USA at the end of 2009 to pursue other opportunities. Chen founded Cognescenti Health Institute, LLC, in Orlando, Florida, and sold the laboratory testing company to Sonic Healthcare in 2006.
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