MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis

Coverage is limited to adult patients (>=18) with confirmed moderately to severely active RA who have failed, are intolerant to, or have a contraindication to at least one csDMARD and who have not previously had molecular predictive testing (or are being considered for an alternate b/tDMARD class after failure of an initial targeted therapy). Tests must predict response/non-response with accuracy and reproducibility beyond existing clinical data, demonstrate AV/CV/CU supported by peer‑reviewed evidence, have algorithms validated in independent cohorts if applicable, and successfully complete the MolDX Technical Assessment to be considered Reasonable and Necessary.

"Patient is an adult (>=18 years) with a confirmed diagnosis of moderately to severely active Rheumatoid Arthritis (RA)."

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