Editor’s Note: A previous version of this story incorrectly identified XDx as an Australian company.
A California molecular diagnostics company XDx Inc. won an important victory as national insurance provider Aetna Inc., based in Hartford, determined that XDx’s heart transplant test is “medically necessary” more than one year after a transplant, The San Francisco Business Times reports.
XDx’s AlloMap test measures expression levels of 20 genes, allowing doctors to use a simple blood test rather than multiple invasive biopsies to grab tissue samples to determine if a transplanted heart is being rejected, the paper’s online news service said.
Aetna’s decision would likely help validate the AlloMap test further, and that has an impact on cash flow and the bottom line. Notably, 89-employee XDx, based in Brisbane, Calif., often has to appeal each test when insurers initially say they won’t pay for it. Sometimes that goes all the way to an administrative judge.
“We’re getting paid today for tests performed two years ago,” XDx President and CEO Pierre Cassigneul told The Times in a January interview.
AlloMap’s list price is $3,400.
“We’re successful in getting paid close to the list price,” Cassigneul said. “For payers, the standard answer is ‘no.’ Payers usually get it, but we need to catch their attention.”
There are about 2,100 heart transplants in the United States each year, according to XDx, and there are about 20,000 living recipients of heart transplants with an average life expectancy of about 10 years.
