As cheaper genetic testing technology emerges in the coming years, payers will have an opportunity to be more selective when authorizing treatment payouts, according to a new report.
The report, from the consulting firm Arthur D. Little, says that genetic analysis has “moved from the domain of the healthcare practitioner to that of the consumer” because simple, mail-order tests like those available from 23andMe have become more mainstream.
As a result, it is becoming less expensive for consumers to access genetic analyses—and it’s likely to get even cheaper. In fact, the report predicts that an assay that costs $100 in 2017 could drop to just $1 in 2026.
As prices for these tests drop, payers and providers are increasingly referring patients to consumer-oriented services, even though not all insurers will pay for them. For example, Kaiser Permanente recommends Color Genomics as a preferred vendor, and Aetna, Humana and UnitedHealth all approved Invitae for in-network diagnostic tests for certain cancers.
In 2015, Anthem became the first insurer to expand its coverage of genetic tests to include non-invasive prenatal testing for “average-risk” pregnancies, the report notes.
Michigan-based Priority Health, meanwhile, covers the cost of comprehensive genomic profiling for members diagnosed with aggressive forms of cancer.
As genetic tests become more readily accessible, payers will face more pressure from patients to reimburse for innovative—and expensive—medications targeted at select populations, per the report.
But the good news is that if payers support genetic tests that identify consumers’ risk for cancers and other disorders, patients will be able to take preventive action or get treated earlier—thus avoiding more expensive treatments down the road.
“Payers will need to avoid wasting funds on treatments that will not work for any given patient, and maximize the selectivity of the treatment regimen,” the report states.
Despite all the promise of consumer-driven genetic testing—especially given what it will mean for precision medicine—some researchers have urged caution when it comes to interpreting those tests, arguing they can be misinterpreted.
In addition, minority groups tend to be underrepresented in genetic databases and thus may not be well served by the prevailing research.