Net New News Special Edition for Clinical Lab Sales

You’ve done everything right. The medical director loves the clinical utility. The lab manager is intrigued by the workflow. And then someone in the room says it — “We’re not sure what reimbursement looks like on this one.”

And just like that, the momentum stalls.

If you sell in the molecular, pharmacogenomics, or advanced diagnostics space, you know this moment well. And honestly? The lab isn’t wrong to hesitate. They’re operating in a genuinely tough environment right now. Under PAMA, the industry has absorbed nearly $4 billion in Medicare reimbursement cuts over the past few years. The 2024 fee schedule brought another 3.4% decrease in the conversion factor for independent labs. Lab closures have been outpacing new openings since late 2022. When a lab pushes back on reimbursement, they’re not being difficult — they’re being smart. They’ve watched margins shrink, seen colleagues get burned, and aren’t eager to add more uncertainty to the pile.

Your job isn’t to argue them out of that caution. It’s to walk in prepared to address it.

The Numbers on Advanced Testing Are Worth Knowing

For newer categories like pharmacogenomics, the uncertainty is even more pronounced — and if you’re selling in this space, understanding the reimbursement landscape isn’t optional, it’s table stakes. A UF Health claims analysis found that only 46% of pharmacogenetic testing claims are reimbursed overall (American Pharmacogenomics Association), with meaningful variation by test type — multi-gene panels came in at 74%, while single-gene tests sat at just 43% (PubMed Central). Geography adds another layer of complexity: Medicare’s expanded MolDX coverage determinations currently reach only 44% of beneficiaries, leaving the rest in states without a consistent policy.

This is the math your lab contacts are running in their heads while you’re still on slide three. Walking in with this context — rather than waiting for them to bring it up — immediately signals that you’re a resource, not just a rep with a bag.

What You Can Actually Do About It

First, know enough to have a real conversation. You don’t need to be a billing specialist, but you should understand the basics: which CPT codes apply to your assay, whether a Local Coverage Determination exists in their MAC jurisdiction, and how coverage has been trending with major payers. The good news is the landscape is genuinely moving in the right direction. UnitedHealthcare has gone on record calling pharmacogenetic multigene panels “proven and medically necessary” Nature for certain prescribing decisions — a significant signal from the largest private payer in the country. Knowing these milestones and being able to speak to them in a conversation positions you as someone worth listening to.

Second, know what reimbursement support your company offers and how to activate it fast. Most companies have resources — a reimbursement hotline, a billing specialist, payer coverage tools — that reps underutilize. Getting a specialist on a follow-up call, or connecting a lab’s billing team directly with your company’s support resources, can be the thing that unsticks a deal that’s been sitting still for weeks.

Third, bring proof wherever you can. Real-world examples of labs successfully billing for a test — especially labs in similar markets or with similar patient populations — will do more work than any reassurance you can offer on your own. Reimbursement rates vary significantly by indication and geography, so a well-chosen, comparable example hits differently than a national average. If you have case studies, use them.

Finally, if full adoption still feels like too big a leap, suggest a limited pilot. A defined patient population, a handful of ordering physicians, a chance to build an actual billing track record before committing to volume. It lowers their risk, keeps the relationship moving forward, and gives you a clear on-ramp to expansion once the reimbursement picture feels more concrete.

The Bottom Line

The hesitation you’re hearing isn’t a no. It’s a not yet — and usually, it just means the lab needs someone to help them see a clear, lower-risk path forward. The reps who win in this environment are the ones who show up prepared, speak the lab’s language, and make moving forward feel smarter than standing still. Be that person, and you’ll close deals your competitors walked away from.