RARE Daily

Illumina and Harvard Pilgrim Expand Access to Whole-Genome Sequencing through Risk-Sharing Agreement

December 9, 2020

Rare Daily Staff

Sequencing giant Illumina and the nonprofit healthcare provider Harvard Pilgrim Health Care said they have entered into a risk-sharing agreement to make whole-genome sequencing available to certain Harvard Pilgrim members starting January 1, 2021.

The program leverages whole genome sequencing 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.

Under the terms of the agreement, Harvard Pilgrim and Illumina will work together to evaluate how insurance coverage of whole genome sequencing impacts patient care and healthcare costs. To date, there are more than 20 peer-reviewed publications demonstrating the clinical utility of WGS in more than 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.

“Our members will be able to take advantage of this comprehensive technology, potentially saving themselves enormous frustration, heartache, and financial challenges,” said Michael Sherman, Harvard Pilgrim’s chief medical officer. “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 whole genome sequencing, through its network of lab providers, for pediatric patients meeting specific criteria. Illumina and Harvard Pilgrim will share the risk on genetic testing costs. Together, the two organizations 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,” said 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.”

Photo: Michael Sherman, Harvard Pilgrim’s chief medical officer

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