Cigna requires counseling before genetic tests


Cigna has announced it will require its members receive counseling before it will pay for them to undergo genetic tests for breast, ovarian and colorectal cancers.

Becoming the first insurer in the country to require such genetic counseling, Cigna created the policy, which goes into effect Sept. 16, because members are increasingly requesting genetic tests--particularly after Angelina Jolie underwent a double mastectomy after genetic tests showed she carried breast cancer genes--yet they frequently misunderstand the tests, reported the Hartford Courant.

The tests, which can cost up to $4,000 each, "are coming at a fast and furious rate," David Finley, Cigna's national medical officer for enterprise affordability and policy, told the Courant. "They have a lot of implications for patients and their families, and they are hard to understand. It's a new field."

Cigna currently either approves or denies members' requests to obtain genetic testing based simply on some of their medical histories. "That standard way of doing it, we did not feel met the needs of our customers because it didn't help to educate them, and this is a very complicated test, which a lot of people--meaning doctors and patients--don't fully understand," Finley said.

Now, the insurer will rely heavily on the genetics counselors' recommendations about whether a genetic test is necessary and what type of test the member should have.

What's more, Cigna wants to ensure its members receive good quality care and that it doesn't unnecessarily pay for tests lacking clinical value. But the insurer clarified the genetic counseling decision isn't financially driven. Finley said any savings resulting from eliminating unnecessary tests will be offset by higher reimbursement costs for the counseling, Bloomberg reported.

The new policy decision has drawn mixed reviews among healthcare analysts. "If the counseling is solely utilized as a cost-containment measure, patients are likely to be unhappy as the future of medicine will involve individualized care based on one's genetic makeup," Joshua Archambault, the Pioneer Institute's director of healthcare policy, told the Boston Herald.

But Otis Brawley, chief medical officer of the American Cancer Society, thinks Cigna is doing the right thing. "What Cigna's doing is what everybody ought to do," he told the Courant. "We have a large number of women who are concerned that they have a mutation that puts them at risk of breast cancer, and a very small percent of them who actually do."

To learn more:
- read the Hartford Courant article
- see the Bloomberg article
- check out the Boston Herald article

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