Blue Shield of California to cover rapid whole genome sequencing for critically ill children

Blue Shield of California will cover rapid whole genome sequencing for children with unexplained medical conditions, becoming the first health plan in the country to do so. 

Rady Children’s Institute for Genomic Medicine researchers have developed a method of genome sequencing that takes less than three days, getting the results more quickly into the hands of doctors treating children who are critically ill. 

Terry Gilliland, M.D., executive vice president of healthcare quality and affordability at Blue Shield, told FierceHealthcare there are a number of access barriers patients and their families can face if they need such testing, including cost and a potentially lengthy wait for prior authorization processing. 

“We really go out in front of this one,” Gilliland said. “It was a nice congruence of capabilities and desire to the right thing.” 

RELATED: CMS approves Medicare coverage of next-generation sequencing tests for inherited ovarian, breast cancers 

The genomic sequencing allows for experts to scan a child’s genetic makeup for thousands of disorders using a single blood sample, which can be drawn at any hospital and sent to Rady for analysis. 

Rady’s specialists will also work with a patient’s care team on precision solutions to their genetic disorders. 

“Our system is optimized to identify or rule out most genetic diseases in a single test, and provide the medical team at the bedside with child-specific, disease-specific information so they can make better, faster medical decisions,” Stephen Kingsmore, M.D., president and CEO of Rady, said in a statement. 

If the genome sequencing is not covered, families who can most benefit are often forced to rely on philanthropy or research grants to access it. Gilliland noted that 4% of newborns in North America are affected by genetic disease, and severe genetic disorders are a leading cause of death for infants, accounting for 1 in 5 deaths. 

Blue Shield members in employer-sponsored plans or individual and family plans will have access to the testing for any child under 18 who’s currently hospitalized in neonatal or pediatric intensive care for an unknown condition, the insurer said.