Test Pricing and Reimbursement in Genomic Medicine: Towards a General Strategy

Reimbursement in molecular pathology: bringing genomic medicine to patients.

In 2008, the Association for Molecular Pathology (AMP) Economic Affairs Committee (EAC), under the leadership of the late Dr. Jeffrey Kant, embarked on a project to design new Current Procedural Terminology (CPT) codes for identification and billing of molecular pathology services. At that time, payers were confronted with a dizzying array of highly technical method-based CPT codes that describ...

Pharmaceutical Pricing and Reimbursement: Canada

Towards a general test presentation in the test sequencing problem

In this paper we propose an approach to a general test presentation that covers the situations with multiple test outcomes, noiseless tests and unreliable (noisy) tests as the input data for the solutionsof the test sequencing problem. Symptomatic information and modular diagnosis are also easily included within the same frame. An example is given to illustrate the proposed approach.

Physician pricing and health insurance reimbursement

This study was based on physician claims records from three Blue Shield Plans. The principal results are: • Physicians are income-motivated. This means that income incentives can be incorporated into reimbursement systems to achieve specific ends, and that care should be taken to assure that new mechanisms do not create income incentives for physicians to act contrary to policy objectives. • Ph...

Stratified Medicine and Reimbursement Issues

Stratified Medicine (SM) has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R) authorities. However, the int...