Genetic testing insurance coverage trends: a review of publicly available policies from the largest US payers, Personalized Medicine, Future Medicine

Genetic testing insurance coverage trends: a review of publicly available policies from the largest US payers, Personalized Medicine, Future Medicine

Personalized Medicine

May 2013, Vol. 10, No. 3, Pages 235-243 , DOI 10.2217/pme.13.9

(doi:10.2217/pme.13.9)

Research Article

Genetic testing insurance coverage trends: a review of publicly available policies from the largest US payers

Michael D Graf^*1, Denise F Needham¹, Nicole Teed¹ & Trisha Brown¹

* Author for correspondence

Aim: Health plan coverage policies can influence utilization of genetic tests. Our goal was to characterize the current state of test-related policies from US private payers. Methods: We searched the public websites of 206 insurers for coverage policies. We documented the number of policies, tests mentioned, coverage determination and policy effective dates. Results: Approximately one-third of insurers had at least one genetic testing policy. Moderate consistency was seen between payers. Tests in oncology and personalized medicine were most frequently addressed. Half of the policies specifically excluded coverage of a particular genetic service. Nearly half of insurers had at least one out-of-date policy. Conclusion: Genetic services are addressed by many large health plans. Challenges remain in ensuring consistency and currency of payer policy for genetic tests.

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