Precision Medicine

What is Precision Medicine?

Precision Medicine uses advances in genetics to tailor treatment to the individual. Advances in Precision Medicine are already helping to transform the way we can treat cancer. Patients with breast, lung, and colorectal cancers, as well as melanomas and leukemias, for instance, routinely undergo molecular testing as part of patient care, enabling physicians to select treatments that improve chances of survival and reduce exposure to adverse effects. Through the Precision Medicine Initiative, the White House has made accelerating the advances in Precision Medicine a national priority (

What is Amerigroup’s Precision Medicine initiative?

Amerigroup’s precision medicine initiative is an expansion of our Cancer Care Quality Program. The objective of the precision medicine initiative is to provide enhanced reimbursement for routine care to participating physicians (in addition to the covered office visit) as it relates to treatment planning and care coordination for those eligible individuals with advanced cancer who enroll in key nationally recognized precision medicine genomic clinical trials. In order to receive the enhanced reimbursement, the individual must be accepted into the genomic precision medicine clinical trial and oncologist must be responsible for ongoing treatment planning and care coordination while the individual is enrolled in the clinical trial.

What is the Cancer Care Quality Program?

The Cancer Care Quality Program is an innovative quality initiative bringing physician practices evidence-based cancer treatment information that will allow them to compare planned cancer treatment regimens against evidence-based clinical criteria. The Program also identifies certain evidence-based Cancer Treatment Pathways; when in-network providers order a treatment regimen that aligns with an identified Pathway, they may be eligible for enhanced reimbursement.

When does this initiative go live?

The Cancer Care Quality Program is already live in all Amerigroup states. Providers will be able to begin billing for enhanced reimbursement for precision medicine clinical trials starting 3/1/2016.

How does the initiative benefit members?

The Precision Medicine Initiative benefits members by increasing their access to the most advanced and cutting-edge cancer treatments.

Who pays for the drug therapies in the precision medicine initiative?

While the precision medicine initiative provides opportunities for individuals who have failed standard treatments for their cancer to have access to novel therapies provided through nationally recognized clinical trials, the drug therapies are provided at no cost to Amerigroup, Amerigroup members, or employers by the drug’s manufacturers.

Who pays for any testing required to determine an individual’s eligibility for participation in a precision medicine clinical trial?

Any testing required to determine eligibility of an individual to participate in a precision medicine clinical trial will be paid for by the trial sponsor and the drugs are provided at no cost by their manufacturers, so members will not have any liability for the investigational/experimental services.

Who determines whether an individual is eligible to participate in a precision medicine clinical trial?

All individuals must meet the eligibility criteria established by the National Cancer Institute and other organizations sponsoring the selected clinical trials. In addition, as federally mandated for all research studies, individuals participating in any of the clinical trials included in the Precision Medicine Initiative must provide written informed consent following a detailed explanation of their treatment options provided by the treating oncologist.

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