Table 4.
Citation Favorability in Covered and Not Covered 2017 Payer Coverage Policies for WES
| Policies Covering WES | Policies Not Covering WES | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Citation Favorability |
Citation | Blue Shield of CA |
BCBS Michigan |
Independence Blue Cross |
HCSC | Cigna | CareFirst (BCBS) |
United Healthcare |
Highmark (BCBS) |
BCBS Alabama |
BCBS Tennessee |
WellPoint Anthem BC |
Aetna | Humana |
| Favorable* | ACMG 2012 | X | X | |||||||||||
| Dixon-Salazar 2012 | X | X | X | X | X | |||||||||
| Yang 2013 | X | X | X | X | X | X | ||||||||
| Yang 2014 | X | X | X | X | X | X | X | |||||||
| Iglesias 2014 | X | X | X | X | X | X | ||||||||
| Soden 2014 | X | X | X | X | ||||||||||
| Srivastava 2014 | X | X | X | X | X | |||||||||
| Lee 2014 | X | X | X | X | X | X | ||||||||
| Valencia 2015 | X | X | X | X | X | |||||||||
| Farewell 2015 | X | X | X | X | X | X | ||||||||
| Nolan 2016 | X | X | X | X | X | |||||||||
| Stark 2016 | X | X | X | X | X | |||||||||
| BCBSA 2016 | X | X | X | |||||||||||
| Neutral** | Need 2012 | X | ||||||||||||
| Not Favorable*** | BCBSA 2013 | X | X | X | X | X | X | X | ||||||
| BCBSA 2015 | X | X | ||||||||||||
| Other**** | Rehm 2013 | X | X | X | X | X | X | |||||||
| Beale 2015 | X | X | ||||||||||||
| Green 2013 | X | X | X | X | X | X | X | X | ||||||
| Dewey 2014 | X | X | X | X | X | |||||||||
| Taylor 2015 | X | X | X | X | ||||||||||
| Posey 2016 | X | X | X | X | X | X | ||||||||
Favorable was defined as preponderance of conclusions supported the use of WES (e.g. “our study supports the use of WES”)
Neutral was defined as preponderance of conclusions that neither supported nor refuted the use of WES (e.g. “our study provides evidence that next-generation sequencing can have high success rates in a clinical setting, but also highlights key challenges”)
Not Favorable was defined as preponderance of conclusions stated evidence was insufficient to support use of WES (e.g. “Whole exome sequencing is considered investigational”)
Other was defined as studies that were not clinical studies, clinical guidelines, or health technology assessments that did not directly inform the use of WES (i.e. implementation guideline for returning incidental findings or validation of WES, or clinical study on WGS)