Insurers could face pressure to cover more genetic testing

U.S. health insurers may be looking at some difficult decisions when it comes to whether they will cover an increasing array of genetic testing, according to a Kaiser Health News report.

The ongoing debate about how far health plans should go in paying for these expensive tests was put in the spotlight by the recent announcement by Pennsylvania-based Independence Blue Cross that it will cover a complex type of genetic testing for some cancer patients. The test detects DNA mutations that might help decide a patient's optimal cancer therapy.

But only some of the information from genetic testing is useful in terms of making a difference in a patient's treatment and prognosis, making decisions about paying for such testing a challenge for payers, Donna Messner, vice president and senior research director with the Center for Medical Technology Policy, told KHN.

The center--a nonprofit organization working with insurers, genetic test companies, patient groups and clinicians to develop a common approach to insurance coverage--has recommended changes in guidelines so that tests that assess five to 50 genes would no longer be considered investigational and would be covered by all U.S. health plans, according to the report.

While some types of genetic tests are commonly covered by insurers, the testing Independence will cover goes further. Medicare and most private insurers do not cover whole-genome testing for cancer tumors, the KHN report says. 

Insurers may face pressure from organizations pushing for more coverage of testing. For instance, lung cancer patient advocacy groups have started a campaign with the slogan, "Don't guess. Test."

UnitedHealth Group in December announced it would cover whole genome profiling for stage IV non-small cell lung cancer. But genetic testing is expensive. A 2012 analysis by UnitedHealth said overall spending in the U.S. on genetic tests could reach between $15 billion and $25 billion by 2021, according to the KHN report.

Researchers say having more cancer patients undergo genetic testing could lead to the development of new drugs, vaccines or combinations of treatments, as called for by President Barack Obama's Precision Medicine Initiative. The White House this year also announced its "Cancer Moonshot Task Force" to try to double the pace of progress against the disease.

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