Hartford Business Journal

16 Hartford Business Journal • May 18, 2015 www.HartfordBusiness.com He's planning to pitch it mostly through doc- tor-to-doctor and patient-to-patient referrals and social media. He projects he can grow sales of the company's genetic-testing prod- ucts to $2.5 million this year, up from $1.96 million in revenue in 2014. Taking a mass-marketing page from the pharmaceutical industry, Ruano is pitching MedTuning directly at consumers whom either can afford to pay out-of-pocket around $1,500 for the genetic survey, or eventually mount enough pressure on health insurers to pay the cost. "The need for MedTuning came from the marketplace,'' said Ruano, a personalized- medicine pioneer-inventor who founded and later sold a New Haven biopharma company in the 2000s. Genomas is affiliated with Hart- ford Hospital's Genetic Research Center, where Ruano is its director. Next-generation testing Where Genomas hit its stride providing genotype testing and evaluation to determine the most efficacious drug combinations in patients suffering depression and other mental ailments, MedTuning takes it one step further, Ruano said. Even as medical advances occur almost daily, one of the remaining conundrums for physicians and patients is figuring out the ideal drug or drug combination, and dosage, particu- larly for those suffering multiple ailments such as heart disease and diabetes. Information of that kind could be invaluable to the nearly half of all Americans who regularly take some type of medication, Ruano said. Genomas was built with that bioinfor- matics foundation in mind, and MedTuning is a natural outgrowth of continuing research and development and refinements, he said. With a genetic blueprint as a guide, physi- cians ply MedTuning's algorithm to analyze, in real time, which of some 300 aging drug brands and their generic equivalents might work best alone, or in combination, to treat a host of patient ailments, Ruano said. "At this point in time, timing is perfect for MedTuning because they're mostly generic yet the drugs are well-known to medical profession- als. They have experience with them,'' he said. Here's a typical situation, Ruano said, when genetic testing comes in handy: A patient with multiple ailments contacts her primary-care doctor, who refers her to several different medical specialists, each of whom prescribes a cocktail of assorted drugs. Occa- sionally, physicians and patients dosed with each drug, are unaware whether the drugs are working or not, or whether one or more drugs is counteracting the others, setting the patient up for an allergic reaction, or worse, poison- ing or overdose. Patients often stop taking drugs if side effects are too great. MedTuning aims to minimize those hur- dles, Ruano said. Assessing patients' geno- type against the myriad outcomes from a physician-prescribed drug regimen reduces patient risks while maximizing treatment results — the goal of every doctor, he said. But genetic testing and usage of health- care algorithms like MedTuning aren't cheap. So insurers' willingness or reluctance to pay for leading-age treatment technologies can have a major impact on whether doctors will order such tests for their patients. Ruano said Geno- mas sold more than 3,000 of its genotype testing for certain patients with men- tal illnesses in 2014, making it the compa- ny's best year since its 2003 founding. His own research, he said, found that many patients who have health savings accounts to compen- sate for their high- deductible health plans are more apt to pay for MedTuning's bioinformatics assessments. Ruano says he cannot understand insur- ers' reluctance in the face of growing global evidence that treatments delivered based on patients' genotypes can be highly effective. Uncertain waters Three of Connecticut's top health-plan pro- viders — Anthem Blue Cross, Aetna and Cigna — say they do pay for certain kinds of genotype testing, if they are "medically necessary." The rest aren't covered, they say, because they are deemed experimental. Each insurer has its own criteria for when a genetic test might be covered. Anthem, for instance, says it deems genetic testing medically necessary when: the genetic disorder is associated with a potentially signifi- cant cancer; the risk of the significant can- cer from the genetic disorder can't be identified through biochemical or other testing; or a specific mutation, or set of mutations, has been established in the sci- entific literature to be reliably associated with the risk of devel- oping malignancy, among other criteria. Insurers also contend that if they paid for every genetic-based test or treatment known to exist, it would open the door to overuse or misuse by caregivers and their patients. Over testing is a major driver of U.S. health- care costs, so it is a valid concern, say some involved in the personalized healthcare sec- tor. Along with new or generic drugs and treatments, insurers are regularly asked to weigh the efficacy and reimbursement for everything from medical devices to new in- home care services. Despite a number of genetic tests and treatments that have undergone rigorous peer review before being embraced as part of the standard of care, it takes lots of cash and as long as a decade, if ever, for newcom- ers to break out, experts say. "When an insurer is hesitant to pay for a new drug, technology or service, it's usu- ally because the evidence hasn't convinced them,'' said Amy M. Miller, executive vice president of the Personalized Medicine Coali- tion, an advocacy group in Washington D.C. Ruano is a co-founding director. Another hurdle for unproven drugs and treatment regimens, Miller said, is that the medical community and health insurers often present them with a moving validation target. "They'll say, 'we need evidence','' she said. "Then the innovator brings that forward, and then they'll say, 'that's not enough'. A little more transparency on both sides will help. Personalized medicine is changing the way we all experience medical care, so we have to figure out these issues.'' Into those waters wades Ruano and his MedTuning concept. n from page 1 Plying the market for genotype testing Genomas Inc. founder/CEO Dr. Gualberto Ruano. P H O T O | S T E V E L A S C H E V E R ▶ ▶ ' When an insurer is hesitant to pay for a new drug, technology or service, it's usually because the evidence hasn't convinced them.' Amy M. Miller, executive vice president, Personalized Medicine Coalition CT public colleges saw 22.8 percent tuition increase since 2008 By Emily Jane Fox CNNMoney S ince the recession, tuition has sky- rocketed at public universities across the country, but schools in some states raised their costs more than others. Out of all 50 states, average tuition at four-year public colleges and universities increased the most in Arizona between 2008 and 2015, according to a new report from the Center on Budget and Policy Priorities. The report found that tuition in Arizona has risen by 83.6 percent since 2008, or $4,734 per student, after adjusting for inflation. Connecticut ranked in the middle of the pack at No. 28. Tuition at public colleges and universities in the Nutmeg State rose 22.8 per- cent since 2008, or $1,969 per pupil. Arizona is followed by Hawaii (70 percent increase), Georgia (69.5 percent), Louisiana (67.2 percent), Florida (64.2 percent) and Cali- fornia (62.2 percent). Overall, since the 2007-8 school year, aver- age annual tuition has increased 29 percent, or $2,068, nationally. The silver lining is that while the post- recession years have not been kind to col- lege students, tuition increases have slowed over the last year. The average tuition increase was $107 over the 2014-15 school year, or 1.2 percent. The sharp rise in tuition is a result of deep cuts in state funding to public col- leges and universities after the recession hit. The vast majority of state funding for these schools has yet to recover. States pro- vide about 53 percent of the revenue used to support public schools, according to the report. Without the funding, many schools are forced to make up the difference with higher tuition. As a result, 47 states are spending less per student this school year than they did pre- recession, with only Alaska, North Dakota and Wyoming excluded. The average state is spending 20 percent less, or $1,805, per student in 2015 than they did in 2008; Connecticut is spending 16.7 per- cent less per student. States that have slashed higher education funding the most since 2008 are Arizona (47 percent), Louisiana (42 percent), South Caro- lina (37.9 percent), Alabama (36.6 percent) and Pennsylvania (35.8 percent). The state cuts and subsequent tuition increases have led to more students tak- ing on student loans, and the amount of loans are getting larger as well, the report showed. n

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