As more labs inundate the market with new genetic testing products, insurers are struggling to determine which tests are effective and necessary, leading to a greater focus on prior authorization and utilization reviews, according to Managed Care Magazine.
Insurers have seen an explosion of genetic testing products over the last several years, along with subsequent pressure to cover the expensive tests. Currently, there are about 60,000 different testing products on the market, which range from a few hundred dollars to $6,000, and labs are constantly introducing new tests each week. The influx of products has created a "perfect storm," Don Liss, M.D., vice president of clinical programs and policy for Independence Blue Cross in Philadelphia, told Managed Care Magazine. That leaves insurers to parse out which tests are necessary and effective to patient care.
Others, like Geisinger Health Plan, are conducting their own utilization reviews by accessing internal resources to review the increasingly complex world of genetic testing, and help determine how to pay for large "panels" of genetic tests, according to the article. Regardless of the approach, insurers are giving more consideration to utilization reviews in an effort control the costs of genetic testing before it spirals out of control.
Earlier this year, Independence Blue Cross became the first major insurer to cover next generation whole genome sequencing for a variety of cancers following President Obama's proposed $215 million Precision Medicine Initiative. However, the transition to genetic testing has also sparked discussion about the potential for improper billing.
To learn more:
- read the Managed Care Magazine article