Proove Biosciences and Specialty Health Announce a Positive Coverage Determination by Leading Nevada Insurer for Genetic Testing

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Nevada’s Only Licensed Managed Care Organization, Specialty Health, Provides a Positive Coverage Determination Supporting the Use of Proove Genetic Testing to Improve Outcomes and Contain Costs

By using Proove’s genetic testing platform, we are able to deliver on our efforts to offer a program that focuses on customized care and best-in-class technology

Proove Biosciences and Specialty Health are excited to announce a positive policy decision on the use of Proove Genetic testing to achieve the quadruple aim of improving outcomes, reducing costs, improving patient care, and enhancing clinician decisions in pain management. The positive coverage determination provides Specialty Health clients, which includes municipalities, police departments, and firefighters, with access to precision medicine testing from Proove Biosciences.

Specialty Health announced the decision to approve Proove Genetic Testing on February 22, 2016. The decision to provide coverage is extended to patients who are candidates for, or who have undergone, spinal fusion procedures and are experiencing pain. Coverage is determined on a case-by-case review as needed. “We are excited to integrate the latest innovations in precision-based care into our program, said Jackie Cox, President of Specialty Health. “By using Proove’s genetic testing platform, we are able to deliver on our efforts to offer a program that focuses on customized care and best-in-class technology.”

Several genetic profiles offered by Proove Biosciences are covered by Specialty Health, including the Proove Pain Perception® profile, which identifies key genes linked to why people perceive pain in different ways. In addition, the coverage includes the Proove Opioid Risk® profile as it stratifies patients into low, moderate, and high-risk categories. Every patient in pain is asked to rate it on a scale of 1 to 10. This assessment is both subjective and unscientific. As a result, it leads to treatments based on the level of patient complaint—and not the mechanisms involved in acute and chronic pain. The current standard of care leads to overutilization of prescriptions, unnecessary and expensive diagnostics procedures, and inappropriate surgeries. It comes to no surprise, therefore, that 60% of pain treatments are failing to control pain adequately. As more opioids are prescribed, prescription drug abuse is emerging as a costly and deadly epidemic. According to the Economic Costs of Pain Journal, cost of pain exceeds $600 billion in the United States—and that is more than cancer, diabetes, and heart disease combined.

After hearing of the decision made by Specialty Health, Brian Meshkin, CEO at Proove Biosciences, expressed his excitement about the potential to shift the health care paradigm in a more scientific direction. “Proove is fundamentally improving pain management by giving physicians the information they need to provide better and more cost-effective care. With the epidemic of opioid misuse, many people prematurely refer to opioids as bad drugs; but this generalization over simplifies the problem because opioids are effective at treating certain patients while putting other patients on the path to addiction. With our proprietary technology, we’re able to pinpoint which patients are likely to respond to opioids favorably or unfavorably. This is important because many patients who are over-prescribed opioid medications are put on the path to misuse—and this can result in death. At the same time, some patients in need of pain relief—and those who are genetically predisposed to respond favorably to opioid treatments—are denied care because of an inaccurate belief that every patient responds the same way to opioid drugs. At Proove, we’re focused on delivering value by reducing failure rates due to poor decision-making. We want to contract with every payer—employer, third party administrator, risk manager, and government agency to help solve this problem.”

About Specialty Health
Specialty Health is a Managed Care and Prevention Company that contracts directly with employers and insurance companies performing wellness and prevention, group health, case management, workers-compensation, and training. A URAC accredited company, one of nine in the US, Specialty Health is composed of a managed care organization, a multidisciplinary network, and a wellness and prevention company. Nationally-recognized for its innovative systems to improve care and reduce healthcare spend, Specialty Health is dedicated to improving patient outcomes since 1995.

About Proove Biosciences
Our mission is to change the future of medicine. Proove represents the proof to improve healthcare decisions. We seek to realize a future when clinicians look back and wonder how they could have ever prescribed medications without knowing how a patient would respond. Physicians use Proove Biosciences testing to improve outcomes—both safety and efficacy of medical treatment. From a simple cheek swab collected in the office, Proove performs proprietary genetic tests in its CLIA-certified laboratory to identify patients at risk for misuse of prescription pain medications and evaluate their metabolism of medications. For more information, please visit http://www.proove.com or call toll free 855-PROOVE-BIO (855-776-6832).

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Proove Biosciences, Inc.
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