Talk

Business Week’s Debate Room has just posted a debate on insurance coverage for genetic testing. Frankly, it’s not much of a debate. The pros for insurance coverage are presented by Dr. Philip Reilly, an accomplished geneticist and thought leader. He summarizes the current state and likely future of genetic testing. The cons are presented by Greg Fish, an IT business analyst, who offers the usual fear-mongering.

Of note, industry publication Health Plan Week (formerly Managed Care Weekly) just ran an article on exactly this: “Insurers Are Considering Change to Coverage for Genetic Testing and Related Patient Counseling Services.” At this point, coverage isn’t a matter of pro or con, it’s really a matter of which tests and for whom. Genetic testing is here, payers see the promise, and they’re trying to find the best strategies for coverage.

Genetic tests available in the market today fall into four categories, [says Drew Fromkin, CEO of Clinical Data, Inc.]:

1. Direct-to-consumer tests such as wole genome scans. These tests are least likely to be covered by insurers.

2. Tests that predict the risk of developing a condition for which there is not clear clinical intervention. For example, there are genetic tests that can predict the risk of developing Parkinson’s or Alzheimer’s disease, but ther eis no clinical treatment available for people found to be at higher risk. Insurers rarely cover these tests.

3. Tests that identify “hard to diagnose diseases that do have major impacts on the costs of care,”Fromkin says. For example, Clinical Data, Inc’s FAMILION test detects mutations that can cause cardiac channelopathies, which are rare, potentially lethal heart conditions such as Long QT Sundrome. that condition primarily affects people under the age of 45 and can cause sudden cardiac death. The genetic test can not only help diagnose the condition, but also aid providers in determining whether the best course of treatment is an implantable device or medication, he explains.

4. Pharmacogenetic tests that use genetic markers to help physicians make treatment choices, such as by predicting a patient’s response to a specific drug. The test used to assess patients’ response to warfarin is one example.

Health Plan Week’s article goes on to talk more about the FDA’s unanimous backing of an updated label for warfarin with genetic testing information, and a new program launched last month by Aetna that expands the availability and utilization of genetic counseling.

More about: Long QT Syndrome, FAMILION test, an example insurance policy coverage of Long QT testing, warfarin response testing, Aetna’s genetic counseling coverage

This entry was posted on Wednesday, January 16th, 2008 at 4:09 pm and is filed under Genetic Testing, What We're Talking About. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.