Mastering genomic prior authorization in 2024 – The Success Blueprint

Genetic testing has become an integral part of healthcare, offering valuable insights to inform diagnoses and treatment plans. With over 77,000 genetic tests available and new ones constantly emerging, the challenge lies in ensuring these tests meet specific criteria for coverage by health plans. Prior authorization has become a common practice, standing as the third most frequently authorized treatment behind specialty drugs and high-tech imaging, according to an AHIP industry survey. 

While health plans claim to base their prior authorization programs on evidence based studies, a recent American Medical Association (AMA) survey highlighted concerns among practicing physicians. Approximately 30% of physicians stated that prior authorization criteria are rarely or never evidence-based. This raises questions about the efficacy of the current prior authorization landscape for genetic testing. 

The AMA survey also revealed that physicians experienced care delays for patients requiring prior authorization, and 84% reported an increase in prior authorization for medical services over the past five years. In this rapidly evolving field, staying abreast of the latest genetic tests, evidence, and technology is a considerable challenge for payers. 

To shed light on this complex landscape, Kelly Athman, Senior Director of Medical Affairs at InformedDNA, emphasized the need for genomics prior auth specialists. These specialists can serve as a crucial throughline, offering support for policy development and providing evidence-based criteria for incorporating seamless genomic lab prior authorization solutions.  

In this context, the role of prior authorization becomes pivotal in managing the genomic testing landscape effectively. It not only addresses concerns related to evidence-based criteria but also ensures that patients receive timely and appropriate coverage for emerging genetic tests. 

As a leading healthcare outsourcing partner, Sunknowledge Services Inc in fact specializes in genomic lab prior authorization and other specialties services, offering expertise in navigating the complexities of genomic testing coverage policies. With a commitment to staying current with industry changes, Sunknowledge can play a vital role in streamlining prior authorization processes starting from Prior auth submission to approval. By ensuring 100% authorization submission on the same day and no cost dedicated resources to constantly monitor your genomic lab prior authorization; partnering with Sunknowledge can be quite beneficial. Enhancing the efficiency, the expert today is known for closing all and any prior authorization gaps in no time. 

Looking for more information on Sunknowledge other benefits, call the expert now!