Insurer’s Approval Of Genetic Testing For Some Cancers Raises Questions

Pennsylvania-based Independence Blue Cross’ announcement that it will cover a complex type of genetic testing for some cancer patients thrusts the insurer into an ongoing debate about how to handle an increasing array of these expensive tests. Independence with its approximately 3 million members became the largest insurer 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 sequencing for children with tumors, patients with rare cancers, people with a type of breast cancer called triple negative and patients who have exhausted conventional therapies for metastatic cancer. While the hope is the results will help patients and their doctors pinpoint the best treatments based on genetic differences, there may not be any such drug regimens yet available. It’s also unclear whether the information the tests provide make any difference in a patient’s treatment and prognosis. “The key to all this is if we’re going to advance this whole personalized medicine thing efficiently, we have to get all the insurance companies working in some kind of similar policy … and to incentivize standardized data that can be shared,” said Sean Tunis, founder of the Center for Medical Technology Policy. The collaborative has recommended changes in coverage guidelines so that tests that assess five to 50 genes would no longer be considered “investigational” and would be covered by all U.S. health plans.