Areas of disruption
Care delivery
Biomarker testing has disrupted the way physicians think about testing because it incorporates all biomarkers (genomic and non-genomic) testing that patients with complex disease states such as cancer need and can be useful at multiple points throughout a patient’s care journey. Biomarker testing may disrupt diagnosis by allowing for more specific diagnoses, and as a result, this will have implications on treatment matching, and treatment monitoring and response.
Cost/payment models
Payment models for biomarker testing and reimbursement is an evolving landscape, but coverage tends to be better under Medicare and large employer-sponsored plans.
Additionally, reimbursement for biomarker testing is not consistent across therapeutic areas and different commercial health plans. As a result, coverage and cost concerns is a barrier to adoption for many health systems and poses a barrier for patients who may benefit from precision medicine the most. Today, health plans are hesitant to cover precision medicine because there is not proof of efficacy at the population level. This reticence is common for rare diseases, where treatments put financial strain on the system for a small subset of the population.
With the advent of new payment models, pharmacogenomics could get patients to the right treatment that is tailored to their specific needs, which could reduce the long-term overall costs associated with the traditional trial-and-error method of care. This in turn would reduce costs in medications over time and hospital readmissions.
A note on health equity
Whether biomarker testing alleviates or exacerbate health disparities will depend on the degree to which genetic data is representative of the broader patient population.
However, some new tests may be taken up less quickly and in lower numbers in underserved and minority populations due to barriers to access, availability, ability to pay privately, and lower health literacy.
For biomarker testing marginalized groups, as well as ongoing community partnerships to advance health equity for all populations, healthcare leaders must think intersectionally about how to address systemic issues and not perpetuate them in practice. There needs to be education and communication considerations specific to build awareness and trust.