Replies to post #195865 on Biotech Values

[DewDiligence]

EXAS—If they were smart they would figure out some way to cap the out-of-pocket costs—better to make a sale (even at breakeven or a small loss) than lose it altogether.

EXAS’ CEO recently stated that, as a matter of policy, EXAS will not sell Cologuard to any US private-insurance plan for less then the Medicare price, which is approximately $500 (#msg-109559217). This statement came before the USPSTF surprise, however, so the Cologuard pricing policy may be under review.

EXAS will sell Cologuard to self-pay patients for $50 up-front and bill them for the balance if (private) reimbursement is not obtained. Most such patients don't pay the residual amount.

[DewDiligence]

[OT/Cologuard]—...not covered by Blue Cross Blue Shield in Massachusetts.

My MD’s practice takes its cues on all procurement matters from Partners Healthcare; since Partners uses FIT rather than Cologuard, my MD won’t order Cologuard even for patients who are willing to pay out of pocket. Due to the Partners relationship, my MD’s practice is likewise inflexible regarding such matters as flu shots—e.g. they carry only the trivalent rather than the quadravalent vaccine.

Although my MD has not disclosed it, I’m pretty sure the MD practice has been acquired by Partners, and hence all of the practice’s doctors and nurses are now Partners employees. Until I figured this out, I couldn’t understand why the practice was unwilling to order the highest-quality diagnostics and vaccines.