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American health insurer will only pay for BRCA test after genetic counselling

27 August 2013
Appeared in BioNews 719

For the first time, a major health insurance company in the USA will require its customers to receive genetic counselling before it will pay for certain genetic tests.

On 16 September, Cigna will introduce its policy stipulating that anyone considering testing for the breast cancer susceptibility genes BRCA1 and BRCA2 must first consult with an approved genetic counsellor.

'We want to make sure these tests are being used according to national guidelines, that our customers are receiving good quality care and that we are not paying for tests with no clinical value', Dr David Finley, a national medical officer for Cigna, told Bloomberg.

Dr Finley added that the tests 'are commonly performed, they have big consequences and they are frequently misunderstood', suggesting that part of the rationale behind the decision was to reduce imprecisions communicated by healthcare staff with minimal training in genetics.

The policy, which also includes testing for genes involved in hereditary colon cancer and the heart condition long QT syndrome, has provoked a mixed reaction.

Rebecca Nagy, president of the National Society of Genetic Counsellors, said: 'We applaud Cigna for recognising the important role genetic counsellors play to help someone make a truly informed decision so the right person receives the right test at the right time'.

'Too often the wrong family member is tested or the wrong test is ordered. This policy will help ensure that Cigna customers receive appropriate testing that will lead to better health outcomes'. A 2010 report from ARUP Laboratories, a pathology reference library, found that 30 percent of complex genetic tests commissioned were delivered with some error in handling by the ordering doctor.

However some commentators are concerned that the policy's guidelines on counselling provision, which include a telephone-only service, may cause problems. Speaking to the Boston Herald, Dr Aubrey Milunsky of the Centre for Human Genetics in Cambridge, Massachusetts, said: 'In our business telephone counselling is a no-no'. He added that specialist medical doctors are better placed to give advice on genetic testing.

Others fear that the policy may be a cost-cutting measure. Joshua Archambault of the Pioneer Institute, a public policy non-profit organisation based in Boston, told the Boston Herald: 'If the counselling is solely used as a cost-containment measure, patients are likely to be unhappy'.

News of the policy triggered a fall in the share price of Myriad, who hold patents on BRCA gene testing, following concern that demand will fall. Ellen Matloff, head of cancer genetic counselling at the Yale Cancer Center, told Bloomberg that the news was 'bad for Myriad's business' as counsellors may advise clients not to get tested as their cancer risk is low or may recommend tests by rival companies.

Cigna Demands Counseling for Breast Test in Myriad Threat
Bloomberg |  19 August 2013
Cigna’s counseling rule draws fire
Boston Herald |  20 August 2013
Cigna to require counseling before genetic testing
SF Gate |  20 August 2013
Genetic Counseling Program Gives Cigna Customers Increased Access to Genetic Counselors (pdf)
National Society of Genetic Counselors (press release) |  23 July 2013
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