BlueCross BlueShield of Tennessee Medical Policy Manual

Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

DESCRIPTION

Genetic panel testing offers the potential to evaluate a large number of genetic markers at a single time to identify treatments that target specific pathways. Some individual markers have established benefit in certain types of cancers and are not addressed under this policy.  The focus of this policy is on the “expanded” panel testing that includes a wide variety of genetic markers in cancers without regard for demonstrated benefits of a specific targeted treatment.

Due to the large number of mutations contained in expanded panels, it is not possible to determine clinical validity for the panels as a whole. The following list contains some (but not all) examples of expanded genetic panels commercially available at this time:

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The concern with clinical utility is the identification of genetic variants that are not clinically important leading to a change in treatment based on variants with uncertain clinical significance. Using molecular panel testing to identify targeted therapies could result in selection of a different, and potentially less effective, treatment than generally chosen based on the type and stage of the cancer.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2016). Expanded molecular panel testing of cancers to identify targeted therapies (2.04.115). Retrieved November 16, 2016 from BlueWeb. (37 articles and/or guidelines reviewed)

Technology Evaluation Center. (2013, June). Special report: Multiple molecular testing of cancers to identify targeted therapies (Vol. 28, No. 1). BlueCross BlueShield Association. (21 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Genetic Test Evaluation (GTE) Report. (2015, December). FoundationOne Heme. Retrieved November 16, 2016 from www.Hayesinc.com/subscribers. (2 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Genetic Test Evaluation (GTE) Report. (2016, May). FoundationOne. Retrieved November 16, 2016 from www.Hayesinc.com/subscribers. (51 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Genetic Test Evaluation (GTE) Report. (2015, August). Paradigm Cancer Diagnostic (PCDx) Test. Retrieved November 16, 2016 from www.Hayesinc.com/subscribers. (1 article reviewed)

Winifred S. Hayes, Inc. Genetic Test Evaluation (GTE) Report. (2016, June). Molecular Intelligence. Retrieved November 16, 2016 from www.Hayesinc.com/subscribers. (31 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Genetic Test Evaluation (GTE) Report. (2016, September). Guardant360. Retrieved November 16, 2016 from www.Hayesinc.com/subscribers. (13 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  12/13/2014

MOST RECENT REVIEW DATE:  1/12/2017 

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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