Priority Health first insurer to cover genomic profiling

(Grand Rapids, Mich. - February 6, 2015)
Priority Health announced today that it is making it easier for patients with cancer to access personalized treatment, by becoming the first insurer in the United States to cover the cost of genomic profiling.

For most insurers, genomic profiling is billed as out-of-network services, requiring patients to pay higher out-of-pocket fees for this potentially life-saving test. Priority Health has changed that, offering coverage for genomic profiling for its members diagnosed with aggressive forms of cancer through Foundation Medicine.

"The decision to cover genomic profiling is about improving the health and lives of our members," said John Fox, M.D., senior medical director and associate vice president, medical affairs at Priority Health. "By covering genomic profiling in specific circumstances, we can help identify alternative and potentially more effective treatment options for those diagnosed with aggressive or difficult to treat cancer."

Priority Health provides comprehensive coverage for members with cancer. From advanced care planning and oncology medical homes to advanced directives and now genomic profiling its members with cancer have access to information about their disease as well as targeted treatment options and resources.

About genomic profiling

Genomic profiling enables doctors to better understand the genomic changes – or gene alterations within DNA that cause 90 to 95 percent of cancers.

Recent studies in genomic profiling show that treating cancer based on genomic changes can be more effective. According to Foundation Medicine, 85 percent of genomic profile cases are actionable - which means a doctor can use the information to create a targeted therapy to treat a specific cancer type.

Targeted therapies' are more successful in treating cancer by attacking the specific genomic changes that add to tumor growth. With these targeted cancer treatments, nearby healthy tissue stays safe and patients experience fewer side effects than with other chemotherapies.

About Priority Health:

Priority Health is an award-winning, Michigan-based non-profit health plan nationally recognized for improving the health and lives of the people it serves. It continues to lead the industry in engaging members in their health, delivering effective health and disease management programs and working with physicians to improve health care outcomes and performance. Priority Health is one of only 20 health plans nationwide offering wellness programs accredited by the National Committee for Quality Assurance, an organization which also rated it among the best health plans in the nation. The State of Michigan named the Priority Health HMO the benchmark plan for all individual and group HMO plans to model.

Priority Health offers a broad portfolio of health benefit options for employer groups and individuals, including Medicare and Medicaid plans. Its network of health care providers features 95 percent of practicing physicians available in Michigan and more than 900,000 health care providers nationwide.