• Policy Issues
• Comparative Effectiveness Research
• Health Information Technology
• Payment Policy
• Regulation
• Research Efforts and Incentives

Payment Policy

Payment policy will have a broad impact on adoption of personalized medicine. Incentives must be aligned with the optimization of individual care via personalized medicine products in order to encourage adoption and development of advances that can help contain health care costs.

To promote the adoption of personalized medicine through payment policy:

• Payment policy should apply evidence in ways that support the physician's ability to deliver personalized care to the individual.
• Health care performance measures adopted by federal agencies should help physicians tailor interventions (including tests, treatments, and care management approaches) based on personalized health care technologies. Health care measures that cover a broad "episode of care" and longer-term outcomes, rather than point-in-time interventions and short-term outcomes, may be one step that supports this approach.
• Provider incentives based on performance measures should allow for exceptions based on individual genetic variations. This allowance will ensure that physicians are not penalized for delivering optimal care for patients who differ from the "average" patient population.
• Performance measures that define economic outcomes should account for differences in treatment cost that may arise as the result of delivering optimal, personalized care based on genetic test results and other information.

Additional Resources

• Decision Memo for Pharmacogenomic Testing for Warfarin Response
  Centers for Medicare and Medicaid Services (CMS)
  August 2009
• Letter to Centers for Medicare and Medicaid Services
  From PMC regarding inclusion of gene expression profiling tests and pharmacogenomic testing in the list of Potential National Coverage Determinations (NCDs)
  September 2008