Report: Employers need to ask these questions before they cover genomic tests

Blood sample
The Northeast Business Group on Health released a guide exploring some of the top questions employers should be asking of health plans about their coverage amid the proliferation of new genomic offerings. (Alden Chadwick/CC BY 2.0)

There's a lot of promise—but also a lot of hype—around the still-emerging science of genetic testing for consumers.

Even so, there are plenty of national brands such as Levi Strauss, Instsacart and Visa that have begun offering insurance coverage for their employers for tests such as screening for hereditary risks for certain cancers and high cholesterol.

But how do employers figure out what's worth covering—and what might not be worth it? The Northeast Business Group on Health this week dipped a toe into those questions Tuesday, releasing a guide exploring some of the top questions employers should be asking of health plans about their coverage amid the proliferation of new genomic offerings.


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"There are exciting advances, but also areas in which the science may not have caught up to the hope," Candice Sherman, CEO of NEBGH, told FierceHealthcare.

RELATED: How some major health systems are overcoming the barriers to launching precision medicine programs

Part of the problem is there is not consistent coverage among payer's policies for genetic tests and therapeutics. Last year, the American Medical Association called for more transparent payment and determination policies for genetic tests and other precision medicine tools.

Other problems, Sherman pointed out, are that some tests are for rare diseases and screening, so testing whole populations can be ineffective and expensive. Sometimes tests generate positive results that turn out not to affect clinical outcomes, or generate anxiety while revealing actionable information. And finally, coverage decisions can impose significant financial burdens and introduce ethical considerations in challenging cases of cancer or rare but fatal diseases.

RELATED: Primary care doctors need help talking to patients about genetic tests

So what are those questions employers should be asking as they define their benefits strategy when it comes to genomic testing coverage? They include:

  • Is your company a trendsetter when it comes to benefits or do you tend to follow standards in your industry?
  • To what extent do you want to reward specific behaviors that could lower costs such as genetic screenings for cholesterol?
  • Are you likely to opt for a generous coverage policy for prenatal genetic testing to avoid complaints among prospective parents?
  • How big a factor is cost in deciding what to cover?
  • If your health plan doesn't cover a specific test ordered by an employee's doctor, how do you want to handle that?

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