Costs and Reimbursement for Caris Molecular Profiling

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The cost of Caris Molecular Intelligence tumour profiling through Precision Oncology is AUD$9,600 including all fees and charges. To order Caris molecular profiling, your oncologist will need to submit a requisition form on your behalf.

Included in this cost is:

  • The complete Caris MI Profile using a CGP+ multiplatform approach;
  • Local pathology laboratory fees;
  • Service logistics (including sending special packaging for the safe transport of tumour samples to the pathology lab where your sample is being held, priority shipping of your sample to the Caris lab in the US, and return of any leftover sample; back to the original lab in Australia/New Zealand);
  • Caris oncologist consultation with your oncologist;
  • Clinical Trials Connector; and
  • Government taxes and banks charges (including GST, bank and credit card fees, transfer fees).

Caris Molecular Intelligence is the only comprehensive multiplatform tumour profiling service in the world with a proven survival advantage, and helps up to 5 times more patients than next generation sequencing (NGS) only services.1

See what’s included in Caris Molecular Intelligence profiling.

Where does this cost come from?

In addition to the services provided by Caris Molecular Intelligence, there are a number of additional costs that Precision Oncology attends to, ensuring that there are no additional fees and charges to you. Precision Oncology staff are there every step of the way. We are available to contact at any time throughout the process and after the final results report has been delivered to your oncologist.

After your oncologist contacts Precision Oncology to order profiling and we organise consent and paperwork, we contact the pathology laboratory where your specimen is located. Pathology labs often charge fees to retrieve and release specimens for further testing. Many other profiling services charge this as an extra cost to be paid by the patient. However, with Caris Molecular Intelligence this is included in the cost. Some pathology labs refuse to release portions of tissue (tissue stored in paraffin blocks) and will only release a specified number of cut slides. Again, there are costs payable to the pathology lab who charge for cutting the tissue into thin pieces and placing on slides. Pathology labs usually charge by the slide; 44 slides are required for Caris profiling.

We have a special shipping kit which keeps the tumour sample safe and cool during transport. We send this to the pathology lab via priority shipping. Sometimes, the sample may be located in more than one lab or research centre, in which case we need to send our shipping kits via express shipping to all these locations. After obtaining the specimen from the pathology lab, it is sent to the Caris Life Sciences Laboratory in Phoenix, Arizona by priority FedEx courier. Precision Oncology organises shipping of the sample and relevant paperwork, and tracks the sample from the moment it leaves the laboratory to the time it arrives at the Caris Life Sciences Laboratory. Precision Oncology also organises return shipping back to the pathology lab via priority FedEx courier. Again, these costs are included in the price of ordering Caris Molecular Intelligence.

Sometimes there isn’t enough tumour in the sample to provide complete profiling. Even if the pathologist is confident there would be plenty of tissue, it’s often not possible to know for sure until the Caris lab staff actually begin to dissect the sample to prepare for profiling. So further tissue may need to be sent. The costs in sending our special kits, organising the new sample for shipping with the local pathology lab, and priority shipping to Caris for this sample are included in the price, in addition to all the tests that need to be re-done for the new sample which is sent over.

How do our costs compare?

Caris Molecular Intelligence is the most comprehensive multiplatform tumour profiling service in the world. Other companies offer tumour profiling for lower prices but provide a service that is not as comprehensive. Caris Molecular Intelligence analyses DNA, RNA and proteins of tumour samples by using technologies including Next Generation Sequencing (NGS), pyrosequencing, in situ hybridisation and immunohistochemistry. Many other services focus only on NGS, which reduces their profiling costs but limits the treatment associations that can be found.

Local laboratories in Australia and New Zealand may offer some genetic testing at a lower cost. However, these are not comprehensive tumour profiling services and usually focus on a select few genes or mutations. In addition, these services are often limited to specific types of tumours, whereas Caris Molecular Intelligence can be performed on any solid tumour sample.

Caris profiling does not compete with testing that is done at the time of initial diagnosis; however, it can be useful as an option for patients where local testing has not found a viable treatment option, or for patients in whom standard of care has failed.

Are the costs covered by Medicare or health insurance?

Currently, Caris Molecular Intelligence is not covered by Medicare or refunded by health insurance companies in Australia or New Zealand, although it is in many other countries around the world. Precision Oncology is currently working to change this. However, there are ways in which you can receive reimbursement for Caris Molecular Intelligence in Australia and New Zealand. The Department of Veteran’s Affairs provides medical reimbursements for veterans and, pending review, may reimburse for Caris Molecular Intelligence on a case-by-case basis.

In other countries, the costs of Caris Molecular Intelligence profiling have been reimbursed as part of health packages offered by employers. In addition, some embassies have covered the costs of profiling for expatriates. Precision Oncology can assist you in contacting your employer or embassy to work out if these are options that are available to you.

Through the Caris Molecular Intelligence Clinical Trials Connector, which is included in Caris Molecular Intelligence profiling, you may be able to gain access to a clinical trial. Suitable clinical trials are identified and included the Caris Molecular Intelligence report for each individual patient. Treatments that are received through clinical trials are free of charge.

Importantly, the vast majority of treatments recommended by Caris profiling are for treatments included under the PBS. This means that the cost of treatment does not increase significantly after the results of profiling are delivered to the oncologist. By contrast, profiling services that use a predominantly NGS approach see a cost explosion in average treatment costs after profiling.2

What if I only want to test for specific mutations?

Caris do not offer single test orders; we perform a comprehensive profile because it has the highest clinical utility. A comprehensive profile allows the physician to see which treatments are likely to have clinical benefit, as well as treatments which are unlikely to have clinical benefit. Our comprehensive profile has achieved the highest quality standards, using widely accepted and validated technologies to deliver evidence based treatment associations.

What if the worst happens and profiling cannot be performed?

Precision Oncology is with you every step of the way, showing compassion and understanding if things do not go as expected. In the very rare occasion that profiling cannot be performed there will be no charge, and any payments made will be refunded in full. Precision Oncology will cover the costs of shipping and specimen retrieval that may have been incurred prior to profiling. Other services offer no refund once the order has been processed, even if profiling cannot be completed. No other service offers the same level of support and compassion as Precision Oncology.

Occasionally, there isn’t enough tumour to provide the full molecular profile and no other tumour is available to send over for testing. However, the majority of results (proteins) require only a very small amount of tissue. In this situation, you will only be charged for the portion of testing which was possible, and the rest will be refunded. The refund amount is calculated on a case by case basis.

Summary

  • Caris Molecular Intelligence is the most comprehensive multiplatform tumour profiling service in the world and as such there are a number of factors that contribute to the overall cost of profiling.
  • While reimbursement through Medicare and private health insurance is not currently available in Australia or New Zealand, there are other options to receive reimbursement for profiling.

References

  1. Janssens J, Gallagher WM, Dean A, Ussia G, Stamp G. Tumor profiling-directed precision cancer therapy – comparison of commercial and academic clinical utility. Int J Surg Surgical Proced. 2017;2:123. [PDF]
  2. Russell KJ, Janssens J, Dean A, Hernandez A, Voss A. Treatment choices based on multiplatform profiling platform, unlike those with sequencing alone, do not cause a cost explosion in refractory cancer patients. Value in Health.2017;20(9):A579. [PDF]
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