February 12, 2016
With approximately 3 million members, Pennsylvania-based Independence Blue Cross announced that it will now cover a complex whole genome genetic test for select cancer patients, raising questions about the usefulness of these expensive tests. UnitedHealth Group conducted a 2012 analysis of national trends that estimated the US could see overall spending on genetic tests reach between $15 billion and $25 billion by 2021.
Genome testing analyzes each specific tumor's DNA. Physicians can now request this genome sequencing for specific patients, including children, patients with rare cancers, triple negative breast cancer patients, and any patient who has exhausted conventional treatments for metastatic cancers. Genetic testing is currently available for >2500 conditions and can identify inherited risks, presence of a disease, and whether a particular treatment might be effective.
It is currently unclear whether the information provided by the tests will make a difference in cancer treatment.
“Only some of the information is useful,” said Donna Messner, vice president and senior research director, Center for Medical Technology Policy. “That’s a challenge for payers.”
Independence CEO Daniel J. Hilferty did not specify the cost of the program but said the number of members to use it will be small. “If evidence shows it works and is helpful, then we can do more," he said.
While most insurers already cover certain genetic tests, such as a breast cancer test that determines if a type of protein is expressed by the tumors, the testing now offered by Independence will go further. It will search for anomalies in >20,000 genes.
“A lot of insurers decide on a case-by-case basis about these tests,” said Lynn Matrisian, vice president of scientific and medical affairs, Pancreatic Cancer Action Network, a patient advocacy group. “Knowing that it’s covered, I think goes a long way in reassuring the patient that they will be able to get some of these therapies.”
While some researchers believe the efforts of the analysis are promising, there is little evidence to support it. However, as studies continue, researchers agree that tumors should be genetically analyzed because the data could help in the development of new drugs and treatments. The hope is to determine the subset of a specific type of cancer or find characteristics pertaining to another type so that oncologists can find drugs to target each individual subset. Drugs meant for one condition may prove useful to treat another with the appropriate genetic features.
“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, Center for Medical Technology Policy.
While all insurers may not cover whole genome testing, patients can get it through an academic medical center or pay for it out of pocket, if necessary.