5 ms·

This is great! I got the Invitae test (due to this: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-cell-carcinoma-and-the-treatments-that-might-save-

This is great! I got the Invitae test (due to this: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-cell-carcinoma-and-the-treatments-that-might-save-me-are-just-out-of-reach/ https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and, from what I understand, FDA approval means it'll be covered by insurance. I've been told by oncologists that blood testing is presently the wild west of cancer profiling. Getting blood testing like CARIS: https://www.carislifesciences.com/products-and-services/molecular-profiling/blood-profiling/ https://www.carislifesciences.com/products-and-services/mole... or Guardant360: https://guardanthealth.com/products/tests-for-patients-with-advanced-cancer/ https://guardanthealth.com/products/tests-for-patients-with-... approved seems important from an insurance standpoint.

capnkap 3y ago
FDA authorization has nothing to do with insurance coverage. I know of a small manufacturer that's had an authorized product on the market for over 3 years, not a single insurance company will cover it. Insurance coverage is basically a waiting game between manufacturers and insurance companies. If you have enough capital to wait it out and schmooze executives, then you can get coverage. If not, good luck to you.
- ethanbond 3y ago
  FDA authorization definitely does have something to do with insurance coverage, it just isn’t a necessary nor sufficient condition.
  - jxf 3y ago
    It is a necessary condition for a number of treatments and insurance companies, but not all of them.
- notQuiteEither 3y ago
  FDA approval makes it considerably easier, and in many cases possible at all, to get reimbursement for these tests. I work in the field and this is a constant hurdle to overcome.
- nradov 3y ago
  In many cases medical insurers outsource decisions on what tests to cover to care guideline vendors such as MCG and Change Healthcare (Optum). Those vendors periodically update their guidelines based on medical research and evidence-based medicine protocols. For a new test to be covered it generally has to demonstrate some clear benefit in terms of improved patient outcomes.
rapatel0 3y ago
FDA approval is but the first step to actual usage by clinicians and reimbursement by insurance companies. You are probably still 2 years away (maybe more) from being able to ask your doctor to prescribe it and getting insurance to reimburse. However, they are now legally allowed to tell you about it and theoretically you can pay for it yourself
- b112 3y ago
  It may seem great, but what happens if you hit these theoretical markers? No insurance? Higher premiums? No treatment, for a prior "known condition"? Required test prior to getting insurance? Renewing?
  - Wohlf 3y ago
    You're really out of the loop, Obamacare eliminated excluding due to prior conditions and differing premiums for anything except smoking. In exchange we all got higher premiums, higher deductibles, and worse coverage across the board.
    - mschuster91 3y ago
      And yet, insurance companies are still making healthy profits [1]. In any case the problem with the US healthcare system is not that now everyone has a sort-of right to insurance, the problem is on the spending side. Y'all spend many thousands of dollars more per capita than the Swiss [2] but have worse metrics across the board. [1] https://www.beckerspayer.com/payer/the-house-always-wins-health-systems-face-worst-finances-in-decades-as-payers-rake-in-record-profits.html https://www.beckerspayer.com/payer/the-house-always-wins-hea... [2] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
      - rapatel0 3y ago
        There are a confluence of reasons behind this state of affairs. - A few fundamental flaws of Obamacare that broke the incentive structure of the healthcare and some regulatory capture. (Granted, the incentive structure has always been a little broken even before Obamacare) - A broken, overly politicized healthcare system in general (something, everyone can agree with) However, people always seem to gloss over this fact: The United States is responsible for vast majority of R&D and revenue in the healthcare sector. Frankly, the US taxpayer and consumer are subsidizing the rest of the world including the Swiss. As a US person, I would love to stop this dynamic and stop hearing this tired, patronizing argument.
huytersd 3y ago
On a possibly crass tangent, how are you doing. Has the situation improved?
- jseliger 3y ago
  I'm doing okay right now: on Wednesday I started receiving a bispecific antibody called petosemtamab (https://jakeseliger.com/2023/09/29/clinical-update-about-where-the-cancer-is-and-whats-happening-with-treatment/ https://jakeseliger.com/2023/09/29/clinical-update-about-whe... for details), and it's likely the best shot I have at more time.

capnkap 3y ago

FDA authorization has nothing to do with insurance coverage. I know of a small manufacturer that's had an authorized product on the market for over 3 years, not a single insurance company will cover it. Insurance coverage is basically a waiting game between manufacturers and insurance companies. If you have enough capital to wait it out and schmooze executives, then you can get coverage. If not, good luck to you.

ethanbond 3y ago
FDA authorization definitely does have something to do with insurance coverage, it just isn’t a necessary nor sufficient condition.
- jxf 3y ago
  It is a necessary condition for a number of treatments and insurance companies, but not all of them.
notQuiteEither 3y ago
FDA approval makes it considerably easier, and in many cases possible at all, to get reimbursement for these tests. I work in the field and this is a constant hurdle to overcome.
nradov 3y ago
In many cases medical insurers outsource decisions on what tests to cover to care guideline vendors such as MCG and Change Healthcare (Optum). Those vendors periodically update their guidelines based on medical research and evidence-based medicine protocols. For a new test to be covered it generally has to demonstrate some clear benefit in terms of improved patient outcomes.

rapatel0 3y ago

FDA approval is but the first step to actual usage by clinicians and reimbursement by insurance companies. You are probably still 2 years away (maybe more) from being able to ask your doctor to prescribe it and getting insurance to reimburse. However, they are now legally allowed to tell you about it and theoretically you can pay for it yourself

b112 3y ago
It may seem great, but what happens if you hit these theoretical markers? No insurance? Higher premiums? No treatment, for a prior "known condition"? Required test prior to getting insurance? Renewing?
- Wohlf 3y ago
  You're really out of the loop, Obamacare eliminated excluding due to prior conditions and differing premiums for anything except smoking. In exchange we all got higher premiums, higher deductibles, and worse coverage across the board.
  - mschuster91 3y ago
    And yet, insurance companies are still making healthy profits [1]. In any case the problem with the US healthcare system is not that now everyone has a sort-of right to insurance, the problem is on the spending side. Y'all spend many thousands of dollars more per capita than the Swiss [2] but have worse metrics across the board. [1] https://www.beckerspayer.com/payer/the-house-always-wins-health-systems-face-worst-finances-in-decades-as-payers-rake-in-record-profits.html https://www.beckerspayer.com/payer/the-house-always-wins-hea... [2] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
    - rapatel0 3y ago
      There are a confluence of reasons behind this state of affairs. - A few fundamental flaws of Obamacare that broke the incentive structure of the healthcare and some regulatory capture. (Granted, the incentive structure has always been a little broken even before Obamacare) - A broken, overly politicized healthcare system in general (something, everyone can agree with) However, people always seem to gloss over this fact: The United States is responsible for vast majority of R&D and revenue in the healthcare sector. Frankly, the US taxpayer and consumer are subsidizing the rest of the world including the Swiss. As a US person, I would love to stop this dynamic and stop hearing this tired, patronizing argument.

huytersd 3y ago

On a possibly crass tangent, how are you doing. Has the situation improved?

jseliger 3y ago
I'm doing okay right now: on Wednesday I started receiving a bispecific antibody called petosemtamab (https://jakeseliger.com/2023/09/29/clinical-update-about-where-the-cancer-is-and-whats-happening-with-treatment/ https://jakeseliger.com/2023/09/29/clinical-update-about-whe... for details), and it's likely the best shot I have at more time.