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. 2013 May;10(3):235-243.
doi: 10.2217/pme.13.9.

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

Michael D Graf  1 , Denise F Needham  2 , Nicole Teed  2 , Trisha Brown  2
Affiliations

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

Michael D Graf et al. Per Med. 2013 May.

Abstract

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 Nearly half of insurers had at least one out-of-date policy.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.

Keywords: genetic testing; genomics; health policy; insurance; insurance carriers; insurance coverage; payer.

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