DNA Direct implements four new health plan clients for molecular diagnostic and genetic tests

DNA Direct, a wholly owned subsidiary of Medco Health Solutions, Inc. and a provider of guidance and decision support for genomic medicine, today announced four new health plan clients that are implementing DNA Direct's Policy & Benefit Support Program for molecular diagnostic and genetic tests. The program enables payors to determine coverage for more than 800 molecular diagnostic and genetic tests and provides real time access to the DNA Direct team of clinical experts for clinical guidance on more than 2,000 tests available today.

Qualchoice of Arkansas, Inc., and Capital District Physicians Health Plan, based in New York, are the first regional plans to implement the program. DNA Direct also provides case review support utilizing its team of genetic experts to provide health plans with on demand coverage guidance. AultCare, based in Ohio, and Bluegrass Family Health, based in Kentucky, are implementing the case review service of the program.

"Molecular diagnostic and genetic testing represents a multi-billion dollar market and is growing at a rapid pace," said Ryan Phelan, Founder & President of DNA Direct. "Due to the increasing number of genetic tests coming on the market, there is confusion among physicians, patients, and payors about which tests are clinically appropriate. We are working with innovative health plans that want to get ahead of the curve and implement an effective strategy to provide the necessary clinical guidance and support for providers and patients."

There are more than 2,000 diseases for which molecular diagnostic and genetic tests are available today, with more than 300 tests becoming available each year. DNA Direct's Policy & Benefit Support Program enables payors to take the first step in managing molecular diagnostic and genetic tests by providing access to an online web log-in based portal that contains detailed clinical information for individual tests as well as coverage decision support. Payors with existing medical policies can more effectively enforce those policies across a broad set of tests and refine clinical policies as necessary to address new technologies as they emerge.

"There are limited resources to support this exploding area of expertise and our goal is to help our clients develop and deploy comprehensive clinical policies for molecular diagnostics to improve quality of care and ensure appropriate testing," said Phelan. "Our services allow our clients to make timely, evidence-based coverage decisions, which helps to improve clinical outcomes and reduce overall healthcare costs."

This program is further supported by unique technology and a call center of genetic experts that provide consistent and up-to-date information about molecular diagnostic and genetic tests. The program's evidence-based policy recommendations are developed using a systematic process that includes extensive and continual literature review, evaluation of the quality of science behind the proposed recommendation, a review of advantages and disadvantages for potential outcomes and the ease of recommendation implementation.

DNA Direct's End-to-End Offering

The Policy and Benefit Support Program is part of a robust end-to-end offering that helps payors manage genetic testing, ensures appropriate testing and improves patient outcomes.

• Coverage Management Program: A complete utilization management solution that enables automated preauthorization of genetic test requests based on comprehensive clinical policies and coverage criteria. The program helps ensure consistent enforcement of clinical policies and enhances the resources that help providers and members make informed clinical decisions about genetic testing and treatment. The web-based preauthorization application automates preauthorization logic for the most common tests and providers can request case reviews for tests that are uncommon or do not initially meet the plan's coverage criteria.
• Decision Support Program: A web and phone-based educational resource that enables members to make informed decisions, identify gene-related risks, and understand when and why genetic testing is indicated. The program includes pre and post test decision support, visual tools and guides that help members understand the impact of genes on family and personal medical history. The program also provides access to professional services, including genetic counseling.
• Clinical Testing Programs: Administrative and clinical physician support programs designed to help members receive the right drug at the right dose, from the onset of therapy. Members obtain the right drugs and dosages that work most effectively and safely for them based on their genotype and plans lower overall healthcare costs by reducing expenses associated with adverse events, disease recurrence and hospitalization.
• Medco's Clinical Decision Support: DNA Direct's offerings are further complemented by the Medco's multiple clinical testing programs and personalized medicine programs. Additionally, the ability to leverage Medco's real-time pharmacy claims and Therapeutic Resource Centers provides DNA Direct clients the ability to optimize overall prescribing and care as well as improve the safety, effectiveness and affordability of medication treatment.