IBC decision to cover complex genetic testing raises questions
Independence Blue Cross' announcement that it will cover a complex type of genetic testing for some cancer patients thrusts the insurer into the debate about how to handle an increasing array of these expensive tests.
Independence Blue Cross' announcement that it will cover a complex type of genetic testing for some cancer patients thrusts the insurer into the debate about how to handle an increasing array of these expensive tests.
The Philadelphia-based insurer - with 3 million members - became the largest to cover whole genome sequencing for select cancer patients. The analysis looks at the entire sequence of each tumor's DNA and identifies mutated genes. Physicians can request this for children with tumors, patients with rare cancers, and those with triple negative breast cancer or who have exhausted conventional therapies for metastatic cancer.
The hope is the results will help pinpoint the best treatments based on genetic differences, but there may not be any such drug regimens yet available. It's also unclear whether the information provided makes any difference in treatment and prognosis.
"Only some of the information is useful," said Donna Messner, vice president and senior research director with the Center for Medical Technology Policy. "That's a challenge for payers."
Cost is also a factor. A 2012 analysis by UnitedHealth Group estimated overall U.S. spending on genetic tests could reach between $15 billion and $25 billion by 2021, up from $5 billion in 2010.
Despite the uncertainties, Independence CEO Daniel J. Hilferty said the insurer felt it was important to try to help some members learn more about their disease. He declined to say how much the program would cost but said the expected number of patients would be small, perhaps in the hundreds.
"Let's jump in the pool," he said of the decision to cover the complex test for a limited group of cancer types. "If evidence shows it works and is helpful, then we can do more."
Patients who want whole genome sequencing analysis even if it's not covered by their insurers can sometimes get it done at an academic medical center as part of a research trial, or pay for it themselves. Costs can run $1,000 to $5,000 or more, advocacy groups say.