Illumina, San Diego, and Harvard Pilgrim Health Care, Wellesley, Mass, announced a risk-sharing agreement to make whole-genome sequencing (WGS) available to certain Harvard Pilgrim members, effective January 1, 2021. The program will leverage WGS to support faster diagnoses of genetic diseases in children, potentially eliminating the long, costly diagnostic odyssey experienced by many families, with the goal of improving patient outcomes.
Diagnosing genetic diseases often takes many years and diagnostic testing costs can exceed $10,000 to $20,000 for some patients. Through this agreement, Harvard Pilgrim and Illumina will work together to evaluate how insurance coverage of WGS impacts patient care and healthcare costs. To date, there are more than 20 peer-reviewed publications demonstrating the clinical utility of WGS in over 3,000 patients with suspected genetic diseases. Health economic models predict that implementing WGS earlier in the diagnostic workup is likely to be cost-neutral or even save payers money.
“Harvard Pilgrim proudly continues to lead the way in agreements designed to promote access for our members to leading-edge precision medicine technology, while containing costs for consumers and employers. We are delighted to have reached this value-based agreement with Illumina,” says Michael Sherman, MD, Harvard Pilgrim’s chief medical officer. “Our members will be able to take advantage of this comprehensive technology, potentially saving themselves enormous frustration, heartache, and financial challenges. Moreover, Illumina gains the opportunity to demonstrate its value in a real-world setting through expanded use of WGS, while Harvard Pilgrim provides additional benefits but deters additional expenses that would otherwise increase costs for our members.”
During the term of the agreement, Harvard Pilgrim will cover WGS, through their network of lab providers, for pediatric patients meeting specific criteria. Illumina and Harvard Pilgrim will share the risk on genetic testing costs. Achieving a rapid diagnosis will prove most valuable for all—ending uncertainty for patient families and potentially halting unnecessary spending on the clinical side. Together, Harvard Pilgrim and Illumina will analyze the data, adjudicate the financials, and prepare a peer-reviewed study for publication.
“There are more than 7,000 known genetic conditions, and yet it can take years for patients and their families and physicians to diagnose their condition—frequently at significant cost in terms of time, money, and emotion, as patients are referred from one specialist to the next,” says Ammar Qadan, vice president of global market access at Illumina. “WGS can dramatically reduce the time it takes to diagnose genetic conditions, which can improve patient outcomes, as well as economics.”