Cigna: Genetic counseling mandates will come for other Dx tests

Cigna already envisions expanding a new policy calling for genetic counseling before it will cover certain diagnostic tests. Make your predictions now as to which additional assays will fall under the controversial requirement.

"We do anticipate that there will be other tests where genetic counseling will be required," Dr. David Finley, Cigna's national medical officer for enterprise affordability, told FierceDiagnostics. "We don't know what they are, but they would fall into the same category of ones that are frequently ordered and often misunderstood."

On Sept. 16, the Connecticut-based national insurer began mandating genetic counseling before it would cover genetic tests that measure susceptibility to breast and ovarian cancer, colorectal cancer and long QT syndrome (a rare, inherited heart condition). Cigna said patients and clinicians frequently misunderstand the tests and the significance of their results, and the insurer wants counseling to reduce their unnecessary use.

As one of the nation's largest insurers, Cigna's implementation of its new genetic counseling requirement will draw close attention in the coming months from other insurers, providers and makers of diagnostic tests. Not every insurer has the same policy--WellPoint doesn't, for example, but UnitedHealth requires genetic counseling for some patients. So Cigna's success or failure under the new requirement could greatly affect the actions of its rivals. It will also shape everything from primary care to the bottom line of diagnostics makers such as Myriad Genetics ($MYGN), which tests for the BRCA1 and BRCA2 genes for hereditary breast and ovarian cancers. Myriad previously told Bloomberg that it would work with Cigna to keep "providing the best possible care for its members."

So far, however, Finley said doctors and diagnostics providers/labs have responded differently to Cigna's policy switch.

"We've gotten a variety of responses," Finley said. "Some doctors think this is great, and some think that this is stepping on their toes, and we are working with those doctors to [resolve] the friction."

He added that providers, diagnostic facilities and labs generally were "neutral" in their response to the new genetic counseling requirement.

"Our policy doesn't necessarily make life easier for them because it adds another requirement to the authorization process for testing," he said. "But they certainly understand that this is in the best interest of Cigna customers, and they are willing to go along with it."

Cigna, he noted, "reached out to both providers, facilities and labs, telling them of our policy, and we asked them for their input. Sometimes we went along with their input and sometimes we didn't. But it is a part of our process to reach out to providers that will be affected by our policies ... and get their input."

Finley emphasized that the new requirement won't limit testing. Rather, he said, it will ensure that increasingly sophisticated tests are ordered, and covered, responsibly.

"The best thing is to see a genetic counselor, and let them take your personal and genetic history to determine whether you meet the criteria. And then you understand the ins and outs of the test," Finley told us. "Most of the time, if they recommend the test be done, we will approve it. What this does is it results in the customer becoming fully informed and educated about the genetic tests their doctor has ordered. And it has provided a very detailed review of the criteria of the testing. Therefore, there will be more appropriate testing, and less inappropriate testing."

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