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Priority Health to cover comprehensive genetic testing

Coverage applies to members with aggressive cancer diagnoses

Comprehensive genetic testingMichigan-based Priority Health plans a bold step in cancer detection and treatment: It will cover the cost of comprehensive genomic profiling for members diagnosed with aggressive forms of cancer, according to the Traverse City News.

Many payers cover tests for specific genetic markers, but John Fox, M.D., senior medical director and associate vice president of medical affairs, said Priority Health is the first insurer in the nation to cover an all-inclusive test.

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. Others contend that test results will lead to potentially unnecessary treatment regimens and therefore increase costs.

That's why Blue Cross Blue Shield of Michigan, Priority Health's primary competitor, covers selective but not comprehensive genetic testing. George Kipa, M.D., deputy chief medical officer of BCBS MI, told Traverse City News that comprehensive genetic profiling "has a low level of reliability."

Fox said the test is meant specifically for patients who are "short on time" and "have failed all existing medications," according to the article. Such patients may only have one chance to undergo such a comprehensive genetic test. The ability of a comprehensive test to determine specific genetic markers or mutations also will help physicians identify clinical trials for which a cancer patient may be eligible, the article said.

The growing popularity and plunging cost of genetic testing has led Cigna to require members to receive counseling before undergoing genetic tests for certain cancers, FierceHealthPayer previously reported. Like Priority Health and BCBSMI, Cigna sees value in such tests but wants to make sure they are conducted only when necessary.

For more:
- here's the Traverse City News article

Related Articles:
Cigna requires counseling before genetic tests
Is genetic testing the future of healthcare?
Should insurers cover genetic tests?
Genetic tests don't drive demand for follow-up care