Cigna to require genetic counseling before some tests

On September 16, a major insurer starts requiring beneficiaries to undergo genetic counseling before they order certain tests. Some doctors are protesting.

 

AIS Health’s Health Plan Week reports that insurer Cigna “will mandate that members considering tests to determine their risk of developing three conditions — breast cancer, colon cancer or the heart rhythm disorder Long QT syndrome — first undergo genetic counseling to gauge whether the tests are needed.”

 

The main reason: The tests can be very expensive. The BRCA breast cancer test – the one Angelina Jolie took before deciding on a double mastectomy – can cost over $3,000.

 

A Cigna executive says about 10,000 members get those tests each year and the insurer believes “about 10% to 30% of these tests are ordered inappropriately,” says Health Plan Week, so they will require that “the customer meets [certain] criteria or has a recommendation from a genetic counselor that they should have the test.”

 

Dr. Michael Cryer, medical director for management consultants Aon Hewitt, tells Health Plan Week he expects other insurers “will pick it up as a way to manage costs.”

 

But some observers, including the American Society of Clinical Oncology, think it’s a bad idea, reports Modern Healthcare.

 

The Society opposes the policy due to its “potential to negatively impact the care of cancer patients by serving as a barrier to the appropriate use of genetic testing services.” Advocacy groups such as Breast Cancer Action and the Sudden Arrhythmia Death Syndromes Foundation complain on similar grounds.

 

Cigna’s policy could be seen at the inevitable result of high genetic test costs, which some critics blame on the greed of the tests’ patent-holders. “If this is the model for the future — when testing for genetic markers is certain to become a far greater part of health care than it is now — we’re all in trouble,” oncologist David B. Agus recently wrote at The New York Times. Agus suggests government intervention in the public interest, the possibility of which would strongly depend upon the political direction of the country in the years to come.