Agreement provides wider patient access to prenatal testing for genetic abnormalities

 (Wellesley, MA) Harvard Pilgrim announced today that it has signed a value-based contract with Illumina that will accelerate wider patient access to a next generation of noninvasive testing for the detection of prenatal genetic abnormalities.  The arrangement makes the test available to younger women, under age 35, with average-risk pregnancies who can now benefit from the new technology. 

Once again, Harvard Pilgrim continues to lead the way in contracts aimed at containing costs for consumers and employers. While Harvard Pilgrim has signed numerous, outcomes-based agreements for pharmaceuticals, this is the first agreement it has entered into for next generation sequencing. The collaboration also includes a two-year, real-world study in the Harvard Pilgrim population that will assess the total costs and clinical outcomes of non-invasive prenatal testing versus traditional screening practices. 

“Harvard Pilgrim is delighted to have reached this first-of-its-kind agreement with Illumina that allows us to expand eligibility for prenatal genetic testing,” said Michael Sherman, Chief Medical Officer of Harvard Pilgrim Health Care. 

As part of this agreement, Harvard Pilgrim will add pregnant women under the age of 35 to those eligible for the test.   While it is anticipated that the cost of this test will be offset by reduced expenditures on other screening modalities, Illumina is committing to cover any potential increased costs in order to make this policy change with an eye toward ensuring affordability.

 “While we have entered into innovative outcomes-based agreements for pharmaceuticals, this is the first agreement we have secured for a screening test, and we hope that it will provide a model for balancing access and affordability for advances in personalized medicine,” said Sherman.

Illumina’s contract with Harvard Pilgrim will also help create real-world data needed by payers and employers to demonstrate the clinical and economic value of the testing for detecting fetal genetic anomalies. 

“We are thrilled to partner with Harvard Pilgrim on the first ever value-based contract of its kind involving next generation sequencing-based assays,” said Ammar Qadan, Vice President, Global Market Access at Illumina. “We expect this study to demonstrate the value of next generation sequencing for average-risk pregnancies and to help accelerate the adoption and reimbursement of non-invasive prenatal testing.”

About Harvard Pilgrim Health Care 
Harvard Pilgrim and its family of companies provide health benefit plans, programs and services to more than 3 million customers in New England and beyond. A leading not-for-profit health services company, we guide our members –  and the communities we serve – to better health.    
Founded by doctors nearly 50 years ago, we’re building on our legacy. In partnership with our expansive network of doctors and hospitals, we’re improving health outcomes and lowering costs through clinical quality and innovative care management.  
Our commitment to the communities we serve is driven by the passion of the Harvard Pilgrim Health Care Foundation. Through its work, low- and moderate-income families are gaining greater access to fresh, affordable food — a cornerstone to better health and well-being. 

Joan Fallon
Harvard Pilgrim Health Care
(617) 509-7458