Insurers Feel Their Way Through Genomic Profiling
Like fingerprints, genes are unique to each person. Records from before the year
Genetic testing to help cure disease still is a relatively young science. Insurers are feeling their way through the evolving research, trying to determine who can benefit from which tests at what price.
"We're providing additional information to physicians," said
"The decision to cover comprehensive genomic profiling is about improving the health and lives of our members," Fox said. "By covering comprehensive genomic profiling in specific circumstances, we can help identify potentially more effective targeted treatment options for those diagnosed with aggressive or difficult to treat cancer."
"Selective genetic testing is covered by
"We've been very interested in the field of genetic testing. We don't cover whole-spectrum genomic testing, which has a low level of reliability," Kipa said.
Fox said Priority's decision to cover the all-inclusive version of genetic testing is aimed at patients who may have only one opportunity to undergo such a test. Ravaged by disease, they may not have the time to take a series of tests for specific types of gene markers. The comprehensive profile will give doctors information about all the patient's genetic markers in a single test.
The comprehensive profile also will provide physicians with information to help determine if a patient is eligible to participate in clinical trials. Such drug trials typically require that a patient have a particular genetic marker or mutation to take part.
"It's better than no information at all," Fox said. "It's certainly for patients who are short on time. When patients have failed all existing medications, we're covering this test."
Blue Cross Blue Shield of
"There's a lot of research going on in this field," Kipa said.
Blue Cross Blue Shield of
The group aims at keeping track of the exponential growth in genetic testing and at improving the quality of care for patients who can benefit from such testing.
The consortium's goals are listed as: Determining which tests are clinically actionable; reducing or eliminating tests that are not clinically actionable; improving the quality of molecular diagnostic testing by evaluating and disseminating best practices for ordering and performing clinically-indicated tests; educating and equipping providers with the tools, resources and expert analysis of outcomes research to test, advise and treat their patients.
"We need to figure out what the right approach is," Kipa said.
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