Currently Viewing:
Currently Reading
Unmet Care Targets Suggest Need for Improved Diabetes Care Accessibility
August 18, 2019 – Alison Rodriguez
Blood Clots in MPN Related to Higher Cost, Length of Stay for Patients With MPN
August 17, 2019 – AJMC Staff
Researchers Seek to Determine Genetic Variability in Parkinson Progression
August 17, 2019 – AJMC Staff
FDA Panel Backs Use of Descovy for HIV Prevention in Men, Transgender Women
August 16, 2019 – Jaime Rosenberg
Researcher Excited About Future of Psoriasis Treatment
August 16, 2019 – Allison Inserro
This Week in Managed Care: August 16, 2019
August 16, 2019
AJMC® in the Press, August 16, 2019
August 16, 2019 – AJMC Staff
Pediatric Leukemia Treatment Linked to Increased Risk of Infections, Study Finds
August 16, 2019 – Alison Rodriguez
5 Findings From the August 2019 Issue of AJMC®
August 16, 2019 – Christina Mattina

Forward-Thinking Insurers Adopt Genomics, Medicare Makes Perilous, Costly Leap Backwards

Ellen Matloff, MS; Danielle Bonadies, MS; Meagan Farmer, MS
Authors from My Gene Counsel discuss gaps in CMS reimbursement policy for genetic testing and counseling, in light of advances in guidelines from groups that include the National Comprehensive Cancer Network. This commentary will appear in the upcoming issue of Evidence-Based Oncology™.
Genetic counselors and providers can also be part of the solution by being proactive, positive, and collaborative.  Genetics is moving too quickly for payers to be up-to-date on best practices.  These payers are not in the field seeing patients and often do not see or understand the gaps that their policies are creating.  They are not genetics experts and need relationships with professional societies, such as the National Society of Genetic Counselors, the American Society of Human Genetics, and  the American College of Medical Genetics to provide fast and efficient guidance.  These societies would be wise to create small internal committees of genetics providers with expertise in payer relations and to then reach out to each payer – including CMS – to offer their services in reviewing policies and providing guidance around them.  We should offer to speak at payer meetings and develop relationships with decision-makers within these plans.  In order to take advantage of the promise of genomics and precision medicine, insurers and genetics experts must be willing to work together to create policies that are effective, efficient, and fair to all parties involved.

Disclosures: Authors are stakeholders in My Gene Counsel, LLC, a privately owned company.

Editor’s Note: This commentary will appear in the August issue of Evidence-Based Oncology™.


  1. Regalado A. More than 26 million people have taken an at-home ancestry test. MIT Technology Review. Published February 11, 2019. Accessed July 9, 2019.
  2. Tandy-Connor S, Guiltinan J, Krempely K, et al. False-positive results released by direct-to-consumer genetic tests highlight the importance of clinical confirmation testing for appropriate patient care. Genetics Med. 2018;20(12):1515-1521. doi:10.1038/gim.2018.38.
  3. Invitae website. Accessed July 9, 2019.
  4. Ray T. Confirmatory testing, insurance coverage grow alongside DTC genetic testing. GenomeWeb website. Published March 22, 2019. Accessed July 9, 2019.
  5. My Gene Counsel website. Accessed July 9, 2019.
  6. Larsen Haidle J, Sternen DL, Dickerson JA, et al. Genetic counselors save costs across the genetic testing spectrum. Am J Manag Care. 2017;23(SP10):SP428-SP430.
  7. Medicare coverage database. CMS website. Accessed July 9, 2019.
  8. Medicare Claims Processing Manual. Chapter 16, Laboratory Services. CMS website.
  9. National Comprehensive Cancer Network. Genetic/familial high-risk assessment: breast and ovarian. Version 3.2019. Published January 18, 2019. Accessed July 9, 2019.
  10. Quinn B. How the CMS NCD in oncology genomics went sideways: 2017-2019. A Discoveries in Health White Paper. Published March 6, 2019. Accessed July 9, 2019.
  11. National Coverage Analysis (NCA) Tracking Sheet for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer (CAG-00450R). CMS website. Updated April 29, 2019. Accessed July 9, 2019.
  12. Klein RD. Medicare should stop blocking access to next-generation sequencing for people with hereditary cancer. STAT News.   Published March 1, 2019. Accessed July 9, 2019.
  13. Quinn B. Has Medicare canceled much of germline BRCA testing, Including for Ashkenazi populations? New 2019 MolDx LCD. Discoveries in Health Policy. Published January 2, 2019. Accessed July 9, 2019.
  14. Mousavizadeh R, Khosravi S, Behzad H, McCormack RG, Duronio V, Scott A. Cyclic strain alters the expression and release of angiogenic factors by human tendon cells. PLoS One. 2014;9(5):e97356. doi: 10.1371/journal.pone.0097356.
  15. Robson ME, Bradbury AR, Arun B, et al. American Society of Clinical Oncology policy statement update: Genetic and genomic testing for cancer susceptibility. J Clin Oncol. 2015;33(31):3660-3667. doi:10.1200/JCO.2015.63.0996.
  16. Access to Genetic Counselor Services Act of 2018. HR. 7083. 115th Congress.
  17. Yang S, Axilbund JE, O’Leary E, et al. Underdiagnosis of hereditary breast and ovarian cancer in Medicare patients: genetic testing criteria miss the mark. Ann Surg Oncol. 2018;25(10):2925-2931.
  18. Drohan B, Roche CA, Cusack JC Jr, Hughes KS. Hereditary breast and ovarian cancer and other hereditary syndromes: using technology to identify carriers. Ann Surg Oncol. 2012;19(6):1732-1737. doi: 10.1245/s10434-012-2257-y.
  19. Levy-Lahad E, Lahad A, King MC. Precision medicine meets public health: population screening for BRCA1 and BRCA2. J Natl Cancer Inst. 2014;107(1):420. doi: 10.1093/jnci/dju420.
  20. Childers CP, Childers KK, Maggard-Gibbons M, Macinko J. National estimates of genetic testing in women with a history of breast or ovarian cancer. J Clin Oncol. 2017;35(34):3800-3806. doi: 10.1200/JCO.2017.73.6314.

Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up