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Aetna, Anthem and Cigna don't cover genetic tests made popular by 'Angelina effect'

Insurers say results unproven, could lead to patients seeking unnecessary care

The "Angelina Effect"--attributed to Angelina Jolie's decision to undergo genetic testing to detect hereditary breast cancer--is sweeping the nation. But some health insurance companies aren't willing to pay for the pricey procedures.

Aetna, Anthem and Cigna, for instance, will not cover the multi-gene panel tests--which can cost between $2,000 to $4,900, reported Reuters. Kaiser Permanente, which insures its own members, covers the tests for patients with family histories of cancer, while UnitedHealth Group covers the tests if patients meet required criteria. Michigan-based Priority Health will cover comprehensive genetic testing, and the insurer says it's the first in the nation to do so, FierceHealthPayer previously reported.

Some insurers believe the tests provide unproven results that are difficult to interpret. This perhaps could lead patients to seek care they don't actually need, noted the article.

While Aetna pays for testing of individual genes, the insurer's medical director of quality management, Robert McDonough, told Reuters that "the routine application of a panel would be considered unproven."

Similarly, Cigna's David Finley, national medical officer for enterprise affordability, told Reuters that multi-gene tests are more likely to find unknown mutations for which there are no care guidelines.

For insurers to get on board with covering the tests, there needs to be more clinical trials and research to establish precise risks and medical guidelines for each type of gene mutation, Finley added.

However, the lack of insurance coverage presents a Catch 22, Mary Daly, a physician who chairs the National Comprehensive Cancer Network guidelines panel for breast and ovarian cancer, told Reuters. If insurers neglect to pay for the tests, there won't be enough data to determine how effective they are. Ultimately, a lack of coverage could hurt the patient in the long run.

"In general, the trend is moving toward more genes," Carin Espenschied, a senior products manager at Ambry and a genetic counselor, told Reuters. "Research and insurance companies kind of just have to catch up."

The debate about whether health insurance companies should cover genetic tests is not a new one. Some say genetic testing is the future of healthcare, poised to lower overall healthcare costs by improving disease prevention, FierceHealthPayer previously reported.

For more:
- here's the Reuters article

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Priority Health to cover comprehensive genetic testing