Anthem Blue Cross Connecticut LAB.00042 Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy Form

This document addresses molecular signature testing (PrismRA, Scipher Medicine, Waltham, MA) to predict response to Tumor Necrosis Factor inhibitor (TNFi) therapy. The molecular signature test includes RNA sequencing and gene expression data to determine if an individual is unlikely to respond to TNFi therapy.

Position Statement

Investigational and Not Medically Necessary:

Molecular signature testing to predict response to Tumor Necrosis Factor inhibitor (TNFi) therapy is considered investigational and not medically necessary for all uses, including but not limited to guiding treatment for rheumatoid arthritis.