Payer Perspectives on Genomic Testing in the United States: A systematic literature review.

Purpose: Healthcare stakeholders' perspectives on the value of genomic testing vary widely and directly impact the access and practice of genomic medicine. A review of United States healthcare payers' perspectives on genomic testing has not been performed.

Methods: We conducted a systematic literature review of US payers' perspectives on genomic testing in the MEDLINE, PubMed and CINAHL databases. Of the 161 nonduplicate records screened, we summarized findings from 20 included records and using the framework method, common domains were recorded.

Results: Domains included clinical utility, coverage decision frameworks, potential harms, costs, "paying for research," demand/pressure, the flexibility of outcomes considered, and personal utility. There was consensus on the definition of clinical utility as improved health outcomes, and the nuances of genomic testing were reported as challenging to fit within existing coverage decision frameworks. Perspectives varied on accepting broader outcomes or uses of genomic testing and whether costs influence coverage decisions. Study methodologies were heterogeneous.

Conclusion: A deeper understanding of how payers approach genomic testing may allow comparison to other stakeholders' perspectives and may identify challenges, opportunities, and solutions to align a conceptual and evidentiary framework better to demonstrate the value of genomic testing.