Liquid Biopsy · @Liquid_Biopsy
1st Sep 2015 from TwitLonger
PiperJaffray: $SQNM The Ball Continues To Roll; Average Risk #Coverage Moves To #Eight
We found BS of California (~2.3M covered lives) and BCBS of Western New York (~0.5M
covered lives) are now covering average risk NIPT during our latest reimbursement
database update, resulting in eight payers total. Specifically, Anthem, Regence, BCBS
of South Carolina, Arkansas BCBS, BCBS of Kansas City, Horizon BCBS New Jersey,
and now BS of California and BCBS of Western New York (~41.5M lives in total,
was ~38.7M) cover NIPT for average-risk mothers. Importantly, both coverage policy
updates come only months after their last revision (was May 2015 for BS of California
and July 2015 for BCBS of Western NY) and were not part of the 15 payers still expected
to update their policies 2H15. Overall, we remain encouraged by the constant flow of
average risk coverage decisions following ACOG's update and view it as a positive for
ILMN, NTRA and SQNM.
• Average Risk Coverage Continues To Grow: We updated our NIPT reimbursement
database finding eight payers now covering both high- (>35 years old) and averagerisk
mothers (<35 years old). Specifically, Anthem (~31.1M covered lives), Horizon
BCBS New Jersey (~2.8M), BS of California (~2.3M), Regence (~1.9M), BCBS of
South Carolina (~1.3M), Arkansas BCBS (~0.8M), BCBS of Kansas City (~0.8M) and
BCBS of Western New York (~0.5M) find NIPT medically necessary in all women
with singleton pregnancies; multiple gestation pregnancies are still investigational/
experimental. Importantly, BS of California and BCBS of Western New York's
coverage decisions come only four and two months after their last revision,
respectively, suggesting 15 payers are still expected to update their policies by year-end.
• Our Thoughts: We are encouraged to find payers updating their coverage policies
quickly after ACOG's latest update. As a reminder, the American College of
Obstetricians and Gynecologists (ACOG) updated its guidelines late June (see our
note here) removing the age restriction for NIPT (was mothers >35). While we
anticipated gradual releases of average risk coverage decisions, the rapid traction
(~41.5M lives in ~2 months) leaves us bullish on near-to-mid term average risk
reimbursement.