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Getting The Right Treatment To The Right Patient At The Right Time

Genentech is focused on realizing the promise of personalized healthcare by working with health care advocates to educate policymakers on the value of patient access to and insurance coverage of biomarker testing.

About Biomarker Testing

Biomarkers are an essential part of “personalized” or “precision” medicine that provide necessary information for appropriate therapeutic intervention.

Biomarkers (short for “biological markers”) are characteristics of the body that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include, but are not limited to, gene mutations or protein expression.

Genetic variations play an increasingly important role in personalized healthcare because they can help healthcare professionals identify which patients may benefit from specific treatments. With biomarker testing, patients can receive the specific treatment best suited to combat their specific disease. A growing majority of new trial results and FDA approvals in cancer, for instance, are for targeted therapies with associated biomarkers.

The scope of precision medicine is growing rapidly. Where today testing is used mainly in cancer diagnosis, prognosis, and treatment, several other disease areas are showing actionable biomarkers. The FDA has approved more than 430 medicines for targeted therapies in more than a dozen disease areas, and many of those therapies have associated biomarkers.

With biomarker testing, patients can directly benefit from the promise of precision medicine by receiving the specific treatment best suited to combat their specific disease. Biomarker testing is the key that unlocks the potential of precision medicine.

Ron Mazumder, Ph.D., Vice President, Biomarker Development, Genentech, A Member of the Roche Group

Our Actions

At Genentech, we believe that comprehensive biomarker testing is critical to advancing personalized healthcare. Our goal is to provide patients with better care, leading to better health outcomes at lower costs. Biomarker testing is paramount to achieving this goal.

Currently, many commercial health plans and state Medicaid programs lack coverage of biomarker testing, preventing patients and physicians from making fully informed treatment decisions. But access to biomarker testing is a solvable challenge. We can dramatically improve the outlook for patients and ensure that more people benefit from targeted medicines if we work together across the whole community.

To address these concerns, Genentech is engaging with the healthcare advocacy community to help educate state legislators and regulators on the importance of biomarker testing to ensure that coverage is commensurate with scientific evidence and clinical guidelines.

BIOMARKER TESTING CAN BE USED TO GUIDE MEDICAL DECISIONS, SUCH AS:


  • Which diagnosis should be made?
  • How should the condition be treated?
  • How should the treatment be monitored?
  • Which medicine is most appropriate for the patient?

Barriers to Access

Barriers still exist that prevent patients from benefiting from the full potential of personalized healthcare. Barriers include, but are not limited to: inadequate coverage of biomarker testing by public payers and commercial insurance, out-of-date coverage policies, and low provider and patient awareness of innovation and scientific advancements in both precision medicine and biomarker testing.

Research has confirmed that there are inequalities in our healthcare system for disadvantaged patients who have poorer health outcomes as a result. Access to biomarker testing helps to ‘level the playing field’ for all people regardless of age, race, and socioeconomic status and ensures more patients can access precision medicines.

Joy Russell, Vice President, External Affairs, Genentech, A Member of the Roche Group

Call to Action

We call on state policymakers to take action to:

  • Increase awareness and education of biomarker testing and precision medicine
  • Improve access to biomarker testing to reduce health disparities
  • Ensure coverage of appropriate biomarker testing and precision medicines to improve health outcomes
  • Support access to innovations in biomarker testing and precision medicines by ensuring citizens have access to clinical trials and coverage of associated routine costs

While there is broad coverage for many biomarker tests under Medicare, this is an evolving space that requires continuous review to ensure medically-appropriate, equitable access.

We call on federal policymakers to take action to:

  • Craft policy that facilitates coverage of new technologies once they are established among the medical community
  • Encourage broader adoption of biomarker testing through educational campaigns and appropriate provider reimbursement
  • Ensure equitable testing by addressing patient out-of-pocket costs, as needed, and encouraging more diversity and cultural sensitivity in genetic counselors and other providers

Despite the clear advantages of biomarker testing, many health insurers and Medicaid programs do not provide appropriate access to these critical tests. Policymakers can help change the landscape by making biomarker testing more widely available for patients.

Fritz Bittenbender, Senior Vice President, Access and External Affairs, Genentech, A Member of the Roche Group

Our Position

Genentech supports policies that:

As state lawmakers have realized the importance of access to and coverage of biomarker testing, many are taking action. State legislation is starting to be introduced and signed into law. Genentech is excited to partner with stakeholders and policymakers to support broad access to biomarker testing. For example, in August 2021, Illinois became the first state in the nation to require Medicaid and state-regulated commercial insurance plans to cover comprehensive biomarker testing when supported by medical and scientific evidence. This landmark legislation paves the way for more patients to benefit from the promise of precision medicines and help improve health outcomes.


References

1. Table of Pharmacogenomic Biomarkers in Drug Labeling. https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling