Laboratory benefit managers claim they have demonstrated a reduction in healthcare costs. But are they equipped to make the final decision on whether a predictive test should or should not be covered? Are they causing undue administrative burden and limiting best practice in patient care?
A LBM is a company that manages lab benefits for a health insurance plan. LBMs aim to optimize test utilization and reduce healthcare costs by controlling the funding and payment for lab services. Most LBMs have a team of clinical experts and/or professional partnerships that help them determine their coverage and payment policies.
LBMs could serve as a valuable resource in the ever-expanding field of precision medicine. They may be a useful stakeholder to help reduce confusion and prevent testing barriers for targeted therapy.
However, given their current aim of reducing healthcare costs, not of decreasing barriers in the healthcare system, it is more likely that LBMs will hinder access to precision medicine in the US by adding undue administrative burden, delaying patient care, deterring growth and innovation within the diagnostics industry, and limiting physician and patient choice in their health care management.