Shows how much you know ya little minion...How does it feel so low on the todem pole that you actually have no idea what you are talking about? Has it happened yet? No, but the position and stage is set for it to take place and many insurances are going to provide a payment for low risk within the next couple of years. Shit doesn't happen overnight tinkle berry. Go back to your every day life of sucking at field sales and checking Med Reps for the next best opportunity.
Your ignorance is showing or possibly the fact that you drink a lot of Koolaid. For someone who has been in the lab (esoteric/personalized medicine/genetic/somatic etc) industry for 15+ years we have been through this cycle before.
With the additional pressure of being in network from insurances, the elimination and action to go after companies that alter, minimize, cap or alter copays and deductibles it will be biz as usual for the mid/large reference labs. Any specialty labs will be suffering and looking for someway to stay in biz. Mainly b/c their test can be offered by other labs that have a wider breath of menu, which will lead to deeper discounts through volume contracts.
Ideally this is one of two approaches for any of these specialty labs. 1) Raise capital to stay in biz from investors (could perpetuate things for a little while) 2) Go public to raise funds and use test volume and growth as an example of success although reimbursements wont' follow the test volume due to contract status or utilizing testing outside of clinically determined areas of utilization 3) Thrive off of medicare/medicaid populations of testing where OOP costs to patient doesn't exist....although you better have medicare/medicaid contracts 4) Offer testing to a subset of patients that would "like" to have the testing but can't with other labs due to the legality of copays deductibles etc. NIPT for low risk is a great example of this (often illegal pricing and adjustments of copays/deductibles) Unfortunately, this is also the subset of patients that typically are not reimbursed therefore sales are artificial and leads to very little profit of any sort based on the volume they crank out.
End all be all is that the insurances will contract with fewer labs for deeper discount contracts in an attempt to reduce cost by a very slight margin. The only saving grace is if you truly have a clinical viable test that is propriety. A few examples are: BRCAnalysis (before the supreme court knocked it down for monopoly), Oncotype Dx (before copy cats started to arise), 4KScore (good current example but will be mimicked before to long) etc. NIPT for a span of 2 years before it was copied endlessly.
Typically, these companies with propriety test have protection for a short period of time until the process can be reverse engineered or until a larger lab makes something that it is "close enough" to steal testing away. They will also use it as an opportunity to not contract with those labs stating there is no difference in the larger reference labs version vs the specialty lab with the proprietary test.
As a rep all we can do is find a good speciality test that is proprietary or unique....ride the success for a few year then rinse and repeat.
The larger reference labs will always have the advantage with the insurance companies. Unfortunately they are also the ones that pay like crap and have management that is so dogmatic they only succeed by being cheap and sticking around longer than the others. These management teams rarely change b/c no one that can actually sell sticks around long enough to move up.
Totem pole...by the way.