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McKesson Expands InterQual Clinical Guidelines for Molecular Diagnostics With Over 100 New TestsAugust 20, 2009 |
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Update Includes Pharmacogenomic Tests That Use Genetic Data to Match Patients With Personalized Drug Therapies McKesson announced it has updated its InterQual® Molecular Diagnostics Criteria to cover more than 380 tests, including a new category of pharmacogenomic tests that determine if an individual will be responsive to a drug based on genetic makeup. As the first vendor to provide a comprehensive set of evidence-based criteria to support decision-making for molecular diagnostic tests, McKesson is now extending the power of this offering to help healthcare payors and providers to ensure patients receive the most appropriate medical care and better manage medical spend. The added content in InterQual Molecular Diagnostics Criteria nearly doubles the number of tests included and addresses approximately 85-90 percent of the costs in this growing area. Criteria for over 70 pharmacogenomic tests are now available, including BCR-ABL1 (Philly Chromosome) and C-Kit for response to tyrosine kinase inhibitors used to treat certain types of leukemia, and KRAS for response to tyrosine kinase inhibitors for non-small cell lung cancer and advanced pancreatic cancer. Pharmacogenomic tests, which can predict individual patient response to many specialty pharmaceuticals, help patients get needed, effective care faster. Although they may cost anywhere from a few hundred dollars to over $1,000, these tests have the potential to save as much as $100,000 per year in unnecessary pharmaceutical spending. Growing at a staggering rate, molecular and genetic test volumes have reached 40 million annual tests in the United States and are expected to double to 80 million by 2012 according to Washington G-2 Reports (2008).Though this fast-growing field holds great promise, it also presents challenges for both health plans and providers as they try to determine test appropriateness and stay educated about medical necessity and test efficacy. “By continually expanding the InterQual content, we are tackling one of the fastest growing, most costly and difficult to manage issues for health plans,” said Tammie Phillips, vice president of InterQual for McKesson Health Solutions. “We are continuing to bring clarity to the unknowns surrounding molecular testing such as test appropriateness and coding, so our clients have the tools they need to improve care and outcomes as well as medical policies.” “Without specific coding to represent these advanced tests, our health plan clients are often unable to determine which molecular and genetic tests are currently being ordered, whether they are clinically appropriate, and how to accurately measure their financial impact,” said Matthew Zubiller, vice president for McKesson’s Advanced Diagnostics Management. “In addition to providing plans with evidence-based decision making criteria for hundreds of molecular and genetic tests, McKesson works with their clinical labs to help them evaluate their claims data and measure their molecular diagnostics spend in order to understand the nature of this issue and how it’s truly affecting their medical spend.” The molecular diagnostics content is available in CareEnhance ® Review Manager software as well as through McKesson’s new Clear Coverage™ auto authorization and coverage determination solution. With this new solution, health plans and their providers can automate medical necessity reviews to support real-time, evidence-based molecular test decisions at the point of care and within the health plan organization. Used by over 4,000 healthcare stakeholders including hospitals, health plans and government agencies, InterQual is the gold standard and most widely used evidence-based clinical decision support for health care utilization management. Clear Coverage is among the flagship offerings of McKesson’s Advanced Diagnostics Management solutions, which connect payors, providers and diagnostic facilities to support selection, performance and reimbursement of the right diagnostic at the right time for the right cost. More background on this announcement and McKesson’s Advanced Diagnostics Management solution is available in an online press kit at www.mckesson.com/diagnosticsnews . About McKesson McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to helping its customers deliver high-quality healthcare by reducing costs, streamlining processes, and improving the quality and safety of patient care. McKesson has been in continuous operation for more than 175 years, making it the longest-operating company in healthcare today. Over the course of its history, McKesson has grown by providing pharmaceutical and medical-surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payors; hospital and retail pharmacy automation; and services for manufacturers and payors designed to improve outcomes for patients. For more information, visit us at www.mckesson.com .
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McKesson Health Solutions
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