Genetic tests for the three diseases for which Cigna is requiring counseling are frequently ordered, can be misunderstood, and often have what Finley said are “profound implications” for patients and sometimes their families.
For Cigna enrollees who are seeking testing for the BRCA gene mutations, which are linked to breast cancer in about 5% of breast cancer patients, a genetic counselor first will address criteria such as a patient's family history as well as explain whether the patient is a good candidate for the test. A Cigna medical director will then render a coverage decision for the test based on the genetic counselor's recommendation.
Finley said about 20% of BRCA tests are ordered inappropriately. Until recently, the only available tests for the BRCA genes cost around $3,340. Pre-testing counseling costs around $75 to $100, while post-test genetic counseling runs roughly $50 to $100.
The cost of BRCA testing has been a concern for healthcare providers and patients. The issue was also raised in a recent U.S. Supreme Court gene patenting case. The court ruled that Myriad Genetics, the developer of the only BRCA tests in the U.S., could no longer prevent other laboratories from conducting BRCA tests based on their patents of naturally occurring segments of human DNA.
While Cigna's new policy, which goes into effect Sept. 16, will require patients to pay co-pays or deductibles based on their health plan, the Patient Protection and Affordable Care Act requires insurers to cover genetic counseling for BRCA testing as a preventive service with no patient cost sharing. Genetic counseling for colorectal cancer and Long QT syndrome testing will be subject to cost sharing.
“We think that it is a solid program that makes a lot of sense for quality of care and the satisfaction of the customers,” Finley said.
The company said it is the first national insurer to have such a policy. When asked if the requirements, which will lead to out-of-pocket costs for patients seeking genetic testing for colorectal cancer syndromes or Long QT syndrome, could deter patients from moving forward with counseling or testing, Finley said it is a possibility.
“It's possible for a period of time that will happen,” he said. But, he added, that “more and more doctors and more and more patients will realize that the service is well worth it.”
The policy will restrict Cigna enrollees from choosing genetic counseling from a healthcare professional employed by a lab that offers genetic testing services.
“That's a conflict we don't want to create,” Finley said.
Follow Jaimy Lee on Twitter: @MHjlee