The Obama administration has seen an overwhelming increase of calls for Medicare and Medicaid to cover advanced genetic sequencing of tumors, a step which would help cancer patients and advance scientific research.

Next generation sequencing has been used to analyze tumors in a more comprehensive way, and is a quicker process than former methods. With genetic sequencing doctors can determine whether a treatment would likely help a patient on an individual basis. This type of thinking shows a movement by doctors towards personalized medicine, which focuses on the individual and what will work best for them not what generally works for the population.

Centers for Medicare and Medicare services generally do not pay for comprehensive genome-sequencing, which limits access to the public. Currently the CMS and some private contractors that administer plans will make payments for limited sequencing on a conditional basis.

“We have this weird juxtaposition with the White House and the vice president loving personalized medicine,” said Amy Miller, executive vice president of the Personalized Medicine Coalition. “And CMS often does not pay for it.”

The fight for sequencing is on-going, as proponents attempt to convince insurers that in paying for advanced sequencing they would be paying for “reasonable and necessary” care and not just for the advancement of scientific research.

In an article by the Stat News Dr. George Demetri, a bone oncologist at the Dana-Farber Cancer Institute and member of the American Association for Cancer Research was quoted as saying, “it’s a fascinating standoff because Medicare would say, and ‘You haven’t really proven this is useful so we’re not going to pay for it.’” But Dr. Demetri argues that, “We can’t prove it’s useful because you aren’t paying for it.”

Vice President Biden has been charged with overseeing a task force focused on the cancer moonshot. However, it’s unclear whether Biden will press for Medicare to pay for advanced sequencing. The test can cost into the thousands of dollars range. “As the VP formally convenes government leaders, they will consider this idea along with many others,” a Biden aide told STAT.

Currently there is a disagreement over whether the Obama administration has the regulatory authority to change CMS policy or if Congress is required to take action.

The administration can argue that there is a clear clinical justification for advanced sequencing by referencing cases where patients have exhausted all other options, and therefore, might turn to targeted therapies, which are often prescribed after gene sequencing.

“If there’s a possibility for doing this test and finding a mutation and using a targeted therapy – where there is a theoretical rationale, but it’s in a sense, more or less, a shot in the dark – I think there’s a justification for paying for that,” said Dr. Roger Klein of the Cleveland Clinic.

What are your thoughts? Do you believe Medicare should cover genetic sequencing? What’s the argument against it? Share your opinion below.