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(This December 12 story corrects to Missouri from Montana in last paragraph)
By Caroline Humer and Julie Steenhuysen
NEW YORK (Reuters) – CVS Health Corp said on Thursday it will make it easier for patients with advanced cancer enrolled in some Aetna insurance plans to receive broad genetic gene sequencing tests that can help identify the best drug or treatment for them.
CVS has been running an oncology program in 12 states in which patients prescribed treatment regimens that follow National Comprehensive Cancer Network guidelines automatically receive prior authorization approval, speeding the time to starting their treatment.
It will now add easier access to broad-panel gene sequencing tests to that program for patients in its at-risk Aetna plans, Alan Lotvin, CVS’ chief transformation officer, said in an interview. In at-risk insurance plans CVS, which acquired Aetna last year for $69 billion, takes on the risk of higher member costs.
Other non-Aetna health plans can also buy the CVS program, the company said.
Under the program, genetic sequencing of tumors would be available for patients with late-stage cancer or whose cancers progress after prior treatments, representing about 30 percent of patients, Lotvin said. The testing will be done by Tempus, a next-generation gene sequencing company in Chicago.
Dr. Otis Brawley, professor of oncology at Johns Hopkins University and former chief scientific officer at the American Cancer Society, said the eased access to these genetic tests will help steer patients away from chemotherapy to targeted medicines.
About 10% to 12% of patients with small cell lung cancer benefit from a treatment typically used for certain breast cancers, he said.
“One of the problems has been that these patients don’t get genetic sequencing or they get it so late they can’t benefit from the drug,” Brawley said.
Drugmakers including Bayer AG have introduced medicines that work well against cancers driven by specific rare genetic mutations. But adoption of the broad genetic tests needed to identify those mutations has been stalled over insurers’ concerns that there is not enough evidence to justify paying for their widespread use, Reuters reported earlier this year.
The tests typically cost $3,000 to $5,000, Brawley said.
Lotvin said CVS’ pilot program had produced observational evidence showing that following the national cancer guidelines had resulted in fewer hospitalizations and chemotherapy treatments, improving care, saving money and lessening the side effect burden.
Connecticut, Florida, Georgia, Illinois, Maryland, Maine, Missouri, North Caroline, Nebraska, New Jersey, Pennsylvania and Utah are in the pilot.
Reporting by Caroline Humer in New York and Julie Steenhuysen in Chicago; Editing by Bill Berkrot
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