11 Aug Payer Coverage for Genetic Testing of Cardiovascular Genes Varies by Insurer

MedicalResearch.com Interview with:
Nancy Niguidula, MS, DPH
Doctorate in Public Health in Toxicology
Ambry Genetics
 

MedicalResearch.com: What is the background for this study?

Response: The clinical presentations of many inherited cardiovascular conditions overlap; thus, genetic testing may clarify diagnoses, help with risk stratification, facilitate appropriate clinical management decisions, and aid in identifying asymptomatic, at-risk relatives. A large number of professional societies have developed practice guidelines and recommendations for genetic testing of cardiovascular diseases. These include international and collaborative expert panels that establish genetic screening and treatment recommendations by drawing on evidence-based medicine. To further strengthen the clinical utility of cardiovascular genetic testing, the American College of Medical Genetics and Genomics (ACMG) published a guideline for 59 genes with clinical actionability that should be reported if found on whole exome sequencing, even when unrelated to the testing indication.

MedicalResearch.com: What are the main findings?

Response: In this study, we compared  the published practice guidelines against the 2018 coverage policies of 4 large US healthcare plans (102 million lives covered), across several heritable cardiovascular  conditions. All four plans had different coverage policies for each cardiovascular condition and within different genes of each cardiovascular condition despite established recommendations and practice guidelines.

Very few policies cover multigene panel testing which is the preferred testing method of health care providers due to reduced costs and time to obtain results. 

MedicalResearch.com: What should readers take away from your report?

Response: Payer coverage for cardiovascular conditions is inconsistent and often limited across inherited cardiovascular conditions for the clinically actionable genes with recommendations and practice guidelines established.

These inconsistencies creates barriers to efficient care for patients with suspected inherited cardiovascular conditions

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: To perform further analysis of additional healthcare plans and determine if with established payer policies, healthcare plans are covering cardiovascular testing (and those following their own policies).

 Disclosures? This study was conducted my Ambry Genetics. 

Citation:

SESSION # ABSTRACT POSTER# 289

Discrepancies in Payer Coverage and Practice Guidelines for Genetic Testing of ACMG Cardiovascular Genes

• The clinical presentations of many inherited cardiovascular (CV) conditions overlap, thereby genetic testing may clarify diagnoses and facilitate appropriate clinical management.
• The ACMG published a guideline for 59 genes with clinical actionability that should be reported if found on exome, of which 30 are related to CV conditions.
• We compared the published practice guidelines for CV genetic testing against the 2018 coverage policies of 4 large US healthcare plans (102 million lives covered) and found that payer coverage is inconsistent and often limited across the CV conditions for the clinically actionable ACMG genes.
  Authors: Nancy Niguidula; Jill Dolinsky; Benjamin Feldmann; Illa Hadzimehmedagic; Greg Nogle; Carrie Horton; Tami Johnston; Heather Zimmermann; Zöe Powis
  Conference: Annual Clinical Genetics Meeting (ACMG) 2019
  Date: Thursday, Apr 04, 2019 10:00am – 11:30am

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Last Updated on August 11, 2019 by Marie Benz MD FAAD