Collaboration to expand access to precision medicine for members with late-stage solid tumors

Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, and Foundation Medicine, a pioneer in molecular profiling for cancer, have entered into a value-based agreement to make FoundationOne®CDx and FoundationOne®Liquid CDx, FDA-approved comprehensive genomic profiling (CGP) tests, available to Point32Health members with advanced cancer, including Medicaid members.

“We are proud to be a leader in innovative agreements designed to broaden access for our members to cutting-edge precision medicine technology,” said Michael Sherman, MD, MBA, MS, executive vice president and chief medical officer at Point32Health. “This collaboration with Foundation Medicine will provide our members with access to genomic information to inform use of targeted therapies, immunotherapies, and clinical trials, while avoiding treatments that are less likely to be effective. We are certain this will have a positive impact on the lives of our members living with advanced cancers, while also creating more equitable access to treatment options informed by CGP across our lines of business, regardless of age or income.”

Progress in the understanding of the molecular basis of cancer over the past two decades, coupled with new treatments which target molecular drivers in a tumor, have led to an increasing number of new precision medicine therapies for patients with advanced cancers. FoundationOne CDx and FoundationOne Liquid CDx are validated companion diagnostic tests that help oncologists match their patients to the precision medicine therapies. Use of companion diagnostics can support an evidence-based approach to treatment decision-making that can lead to better outcomes for patients with advanced cancer and help reduce waste in cancer treatment.^1,2,3

The goal of the agreement between Point32Health and Foundation Medicine is to extend health plan access for Foundation Medicine’s FDA-approved companion diagnostic tests to patients with advanced solid tumors through an expansion of coverage criteria. The agreement will explore utilization of CGP’s impact on patient care, health care utilization and costs, and will provide important insights to help physicians make informed decisions about personalized approaches to treatment, including clinical trial enrollment. The agreement is available to Harvard Pilgrim Health Care and Tufts Health Plan commercial members in Massachusetts, Connecticut, Rhode Island, New Hampshire and Maine, and Tufts Health Plan Medicaid members in Massachusetts and Rhode Island.⁴

“Foundation Medicine believes every patient living with advanced cancer should benefit from comprehensive genomic information to inform their care. That’s why we’ve built a powerful portfolio that includes FDA-approved companion diagnostic tests to support oncologists in matching their patients to the right therapies,” says Mia Levy, MD, PhD, chief medical officer at Foundation Medicine. “Our deep understanding of cancer biology helps physicians make informed treatment decisions for their patients and enables more people to benefit from precision cancer care. We are proud to collaborate with Point32Health and expand access to our tests.”

Eligible Harvard Pilgrim Health Care and Tufts Health Plan members with cancer should discuss the option of tumor genomic profiling with their oncologist or other treating physician.

About Point32Health

Point32Health is a leading, nonprofit health and wellbeing organization, delivering a better health care experience to our members and the communities we serve. One of the top twenty health plans in the United States, Point32Health builds on the quality of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care.

At Point32Health, we believe that everyone should have equitable access to affordable, high-quality health care, regardless of their age, race, ethnicity, socioeconomic status, orientation, gender identity or ability. We offer a diverse range of health plans that help improve the health and wellness of the 2.2 million members we serve. Every day, we work to deliver on our purpose of guiding and empowering healthier lives for everyone.

We are proud that our Harvard Pilgrim Health Care Commercial Combined HMO and POS plans in Massachusetts and Maine, our Exchange HMO plans in Massachusetts and Maine, as well as Tufts Health Plan’s Medicaid and Exchange HMO plans, have received full Health Equity Accreditation from the National Committee for Quality Assurance (NCQA).* And for the eighth straight year, our Tufts Medicare Preferred HMO plan received a 5-star rating from the Centers for Medicare & Medicaid Services, the highest rating possible.**

*NCQA’s Health Equity Accreditation program

**Every year, Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov. Tufts Medicare Preferred HMO plans received 5 out of 5 stars for contract years 2016, 2017, 2018, 2019, 2020, 2021, 2022,2023.

About Foundation Medicine: Your Essential Partner in Cancer Care

Foundation Medicine is a pioneer in molecular profiling for cancer, working to shape the future of clinical care and research. We collaborate with a broad range of partners across the cancer community and strive to set the standard for quality, scientific excellence, and regulatory leadership. Our deep understanding of cancer biology helps physicians make informed treatment decisions for their patients and empowers researchers to develop new medicines. Every day, we are driven to help our partners find answers and take action, enabling more people around the world to benefit from precision cancer care. For more information, please visit us on FoundationMedicine.com and follow us on Twitter and LinkedIn.

Source: Foundation Medicine

¹ Milbury CA, Creeden J, Yip WK, et al. Clinical and analytical validation of FoundationOne®CDx, a comprehensive genomic profiling assay for solid tumors. PLoS One. 2022;17(3):e0264138. Published 2022 Mar 16. doi:10.1371/journal.pone.0264138 https://pubmed.ncbi.nlm.nih.gov/35294956/ [pubmed.ncbi.nlm.nih.gov]

² Keeling, Peter. “Transforming the Pharma Business Model to Prevent Lost Treatment Opportunities and Optimize Return on Investment.” Transforming the Pharma Business Model to Prevent Lost Treatment Opportunities and Optimize Return on Investment, Diaceutics, May 2017, www.diaceutics.com/docs/ft-2017-white-paper.pdf [diaceutics.com]. Accessed April 1, 2019

³ Schwaederle M, Parker BA, Schwab RB, et al. Precision Oncology: The UC San Diego Moores Cancer Center PREDICT Experience. Mol Cancer Ther. 2016;15(4):743-752. doi:10.1158/1535-7163.MCT-15-0795

⁴ Not including Tufts Health Plan Unify members, as they have coverage through Medicare.

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