Personalized medicine player MolecularHealth is adding an interesting reimbursement twist to its cancer diagnostics offerings: It figures out insurance options not only for the tests it offers, but also for the ensuing treatment options that are recommended by its tests.
“To avoid disappointment and confusion for a patient, we think it’s best for the patient and physician to have a meaningful conversation up front about not only available treatment options, but also whether their insurance will cover the therapy,” said Laura Housman, senior vice president and chief commercial officer at MolecularHealth.
The Woodlands, Texas-based company’s main product is its TreatmentMAP gene panel, which seeks out more than 600 genetic variants and algorithmically determines the efficacy of a drug. The company’s aim is to offer physicians a kind of one-stop shop for personalized medicine in solid tumor cancers: Once a diagnosis has been made, the company offers information about the cancer type, treatment options and clinical trials, adverse events associated with a drug or a genotype, and reimbursement options.
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But its new, “unprecedented” idea here is to streamline the reimbursement process a touch, Housman said, giving docs and patients information about the nebulous world of testing and treatment insurance options. The tool, called RxAssistance, helps physicians and patients quickly learn whether a payor is likely to foot the bill for the cancer treatment.
“We’re extending the usefulness, and value, by doing the early legwork for a physician,” Housman said. “We work directly with the payor, and find out what its stance is for the therapy – whether it’s FDA-approved, off-label or investigational.”
Typically, the reimbursement arm of cancer care is figured out by the physician’s office. But the issue here, Housman said, is that a typical oncologist might see a dozen patients in a day; their offices don’t have the bandwidth to dig deep into the intricacies of reimbursement. RxAssistance is aimed to be a time-saver in this department.
As part of the diagnostic report, RxAssistance provides information on pre-authorization, patient responsibility for co-pays and deductibles, letters of medical necessity and step therapy requirements or medical benefit formularies, Housman said.
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MolecularHealth has been developing the underlying software for its targeted panel for eight years, but it just began commercializing the test three months ago. The company has been funded by a single investor, Dieveni Hopp BioTech.
