In a first-of-its-kind program, Cigna will begin requiring patients who are at risk of developing breast cancer, colorectal cancer syndromes, or Long QT syndrome to obtain counseling before undergoing genetic testing, Jaimy Lee reports for Modern Healthcare.
Cigna's policy takes effect Sept. 16 and is intended to curb inappropriate utilization of genetic and molecular diagnostic testing, which U.S. health insurers spend millions on annually. Cigna officials say they also want to avoid some of the anxiety and physical harm that can result when a patient receives an unnecessary screening.
"A lot of (genetic testing) is valuable, but a lot of it [is] not valuable," says David Finley, Cigna's national medical officer for enterprise affordability and policy. Moreover, he adds that genetic testing can often be misunderstood and have "profound implications" for patients and their families. "We owe some responsibility to our customers to help them decide," Finley says.
Case in point: BRCA testing
Under the policy, Cigna enrollees who want to be tested for BRCA mutations—which are linked to a heightened risk of breast cancer in about 5% of patients—would meet with a genetic counselor to discuss whether testing is appropriate based on their family history. The insurer would then render a coverage decision for the test based on the counselor's recommendation.
Finley says that about 20% of BRCA tests are ordered inappropriately, and that the tests' expense has provoked concern from health care providers and insurers, Modern Healthcare notes. Until recently, the only BRCA tests available were manufactured by Myriad Genetics for about $3,340. Comparatively, pre-testing counseling costs between $75 and $100.
Initially, Cigna patients seeking genetic counseling for BRCA testing under the new policy will be required to pay co-pays or deductibles, although BRCA screening must be offered at no-cost as a preventive service under the Affordable Care Act. However, genetic testing for colorectal cancer and Long GT syndrome will still be subject to cost-sharing.
Finley told Modern Healthcare that out-of-pocket costs for these tests could deter patients from seeking treatment "for a period of time," but "more and more doctors and more and more patients will realize that the service is well worth it" (Lee, Modern Healthcare, 7/25 [subscription required]).
Next in the Daily Briefing
More than just a pick me up: Coffee may save lives