Close readers of Myriad's November 1, 2022, financial update may have noted this reference to the MolDx program:
- Molecular Diagnostic Services Program (MolDX®) assigned the MyRisk® hereditary cancer test Current Procedural Terminology (CPT) code 81479 and assigned favorable test specific pricing.
What DEX Says
Free user registration at the DexCodes database managed by MolDx gives 3 tests with MyRisk in the title, with "no coverage" stated for one, and with local prices (e.g. not a fixed fee schedule price) for two other versions.
- Myriad myRisk Hereditary Cancer Test (Test 10621) is a "48 gene" test with "risk of 11 cancer types." It's listed as COVERED and locally set price $1743.95.
- Myriad COLARIS Plus + myRisk Update is listed as test 722 and as a germline sequencing and large rearrangement test, COVERED, and locally set price $1299.78.
- Myriad myRisk Hereditary Cancer UPDATE Test. This is listed as NOT COVERED, so there is no price.
Prices online at DEX may lag the most recently assigned prices by a month or two, so exactly $1743.95 might not be the November 1 price noted by Myriad.
"Favorable" is Relative
The description of "favorable" pricing is mixed, as the myRisk test contains BRCA1-2, for which CMS pays about $1824 under code 81162, more than $1743. However, another coding would be 81432/33, which is BRCA plus 8 or more other genes, for which CMS pays only around $1100, much less than $1743.
81479 & PAMA
As I described in my recent analysis of CMS 2021 code & utilization data, here, the Unlisted 81479 MoPath code is the highest paid code in Medicare, at $409M in CY2021 (Part B only). It accounts for 14% of 2021 MoPath payments, or about 20% of non-abusive 2021 MoPath payments (see blog). While we have no data on state-by-state (or lab-by-lab) usage in 2021 yet, in 2020, nearly all 81479 payments were via the MolDx system. Rising levels of 81479 payments means that increasingly, much of the Medicare molecular payment system works separately from the PAMA statutory rate setting system.
Myriad as MYGN
On November 1, share price slipped from about $21 to $17 with the announcement. The one year range is $16-32, the five year range about $12-$50. (Genomics labs have been volatile; the one year range of Natera is about $26-$120 and CareDx $15-$51).
Prostate MAAA Tests
From 2021, the 3 main prostate MAAA tests grew from $56M to $82m (up 42%). Myriad's test grew more slowly (37%) than Veracyte/Decipher (89%), but faster than Oncotype Prostate (5%).