What are the tests? Who are they for?
This new benefit will cover the cost of solid and liquid biopsy testing (FoundationOne CDx and FoundationOne Liquid CDx) provided by Roche Products (Ireland) Ltd for patients with primary lung cancer, cholangiocarcinoma, advanced breast cancer, advanced colorectal cancer and cancer of unknown primary origin.
What are the benefits of the test?
The Foundation Medicine tests assess the complex individual profile of a patient’s cancer. It provides information about clinically relevant biomarkers and genomic alterations to help match patients to approved targeted therapies, immunotherapies and clinical trials, giving Physicians and patients powerful insights for navigating cancer care. This may result in better response rates to treatment, prolonged time to treatment failure, improved survival and Improved Quality of Life.
Not only is it important to identify the driver mutations in a patient’s cancer, it is also critical to identify resistant mutations which will help rule out treatments that will not be of benefit to the patient. The Foundation Medicine tests also identify mutations associated with a particular tumour type that the patient does not have. This helps to rule out treatments that will have little / no clinical benefit.
Targeted treatments can reduce the cytotoxic side effects of some older treatments and can also lead to a reduction in Emergency department visits. It can also help to avoid any unnecessary biopsies.
How is the test done?
CDX is a liquid blood test so you will not need a surgical tissue biopsy, which in some cases can be difficult to obtain and a patient may not have enough tissue to allow a viable sample to be used.
“Thanks to Foundation Medicine Inc I am Here, Happy and Hopeful for the future. As a stage 4, triple negative, metastatic breast cancer patient, I know medical options and my time in this wonderful world are limited.
However, a close friend of mine saw a much longer future for me and suggested I undertake a FMI test. With the hope that results would offer a more complete picture of my cancer and help open up treatment options for me. Once the science behind the test was explained to me and in conversation with my Oncologist, an FMI tissue test was set up for me. This consisted of a sample of tissue from my tumour being sent to FMI in the US for testing.
Less than a month later my test results revealed there was an immunotherapy drug** that would work well with my tumour type, and a list of other immunotherapy drugs that may work well. These results gave me, my family & close friend great hope, great hope that there would be a Mary B in the future. Thank you FMI for ensuring this, and ensuring two little girls will continue to get a goodnight kiss from mum for many more months and hopefully years to come.”
*Patient is an employee of Roche Pharmaceuticals and received a gratuity.
** Immunotherapy drugs are subject to clinical criteria and terms and conditions of your policy being met, each request is assessed on a case by case basis.
Am I covered?
This new benefit will be added to all level 2, 3, 4 and 5 plans from 01 July 2021.
Under this benefit we will cover the cost of solid and liquid biopsy testing (FoundationOne CDx and FoundationOne Liquid CDx) provided by Roche Products (Ireland) Ltd. for patients with primary lung cancer, cholangiocarcinoma, advanced breast cancer, advanced colorectal cancer and cancer of unknown primary origin.
The benefit is only available where it is recommended by an Irish Life Health approved oncology consultant and where the testing has been pre-authorised by Irish Life Health. In addition agreed clinical criteria (available on request) must be satisfied before this testing will be covered.
How does a member make a claim?
Claims will be settled directly with the provider. The benefit is claimed in the same was as In-patient Benefits.
What waiting periods will apply?
If a member upgrades from a level 1 plan to a level 2-5 plan on or after 1 July 2021, the upgrade waiting period will apply to pre-existing conditions.
Initial and pre-existing condition waiting periods will also apply to new members who buy a level 2- 5 plan on or after 1 July 2021 – if they have not served these waiting periods yet.
Members who already had a level 2-5 plan before 01 July 2021 must have served their waiting periods before they can avail of this benefit. However, where members have this benefit added to their existing level 2-5 plans from 01 July 2021 and have already served all their waiting periods, they will not have to serve any further waiting periods to use this new benefit.
Does this benefit require pre-authorisation?
Yes, the benefit is only available where it is recommended by an Irish Life Health approved oncology consultant and where the testing has been pre-authorised by Irish Life Health. In addition, agreed clinical criteria (available on request) must be satisfied before this testing will be covered.