A Glimpse Into Managed Care of Diagnostics

Evidence-Based Oncology, August 2014, Volume 20, Issue SP11

Leaders at New Jersey’s major academic research institutions are enthusiastic about the role that genetics and precision medicine will play in cancer care. However, which genetic and

diagnostic tests gain ground in the market may not be up to oncologists and researchers.

This summer, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) removed Myriad Genetics from its network, becoming the first major carrier to change network status, according to Myriad spokesman Ronald Rogers. Instead, Horizon will coordinate all genetic testing through its in-house laboratory, LabCorp, which has formed a specialty testing group, Integrated Genetics.1 In December, less than 6 months after the US Supreme Court ruling that ended Myriad’s monopoly on BRCA testing,2 Integrated Genetics announced a new national BRCA testing suite called BRCAssure.3

Thomas Vincz, a spokesman for Horizon BCBSNJ, said in an e-mail to Evidence-Based Oncology that Horizon’s longstanding relationship with LabCorp will allow its members to pay

less for services by using an in-network provider, and that, “Horizon believes LabCorp’s BRCA testing is equivalent to testing by Myriad Genetics.”

Myriad, meanwhile, during its fourth-quarter earnings call August 12, 2014, strongly maintained the position that its testing quality and customer service are superior to competitors, based on the experience gained from testing 1.3 million patients. Elsewhere in the market, Myriad has reached relationships with other insurers, notably UnitedHealthcare, to offer its myRisk test to patients.4

But in New Jersey, the Horizon decision is both a financial and policy blow. Not only does Horizon BCBSNJ have 54% market share and 592,630 enrollees,5 but Horizon is a longtime administrator of the self-funded State Health Benefits Program, which covers thousands of public employees and retirees and, this being New Jersey, many lawmakers themselves.6

Of note, Horizon’s relationship with LabCorp does not extend to all tests that LabCorp administers. In January, LabCorp announced the launch of Prosigna, the breast cancer prognostic gene assay from NanoString, which has FDA clearance.7 According to Vincz, Horizon still considers Prosigna an “investigational” assay, and consistent with national policy for the Blues affiliates, it is “not currently a covered benefit for Horizon BCBSNJ members.”References

1. Integrated Genetics. LabCorp Specialty Testing Group website. https://www.labcorp.com/wps/wcm/connect/intgeneticslib/IntegratedGenetics/Home/About+Us/About+Us. Accessed August 14, 2014.

2. Munro D. Supreme Court breaks Myriad monopoly. Forbes website. http://www.forbes.com/sites/danmunro/2013/06/16/supreme-court-breaks-myriad-monopoly/. Published June 16, 2013. Accessed August 14, 2014.

3. LabCorp to offer BRCAssure breast cancer mutation tests [press release]. Burlington, NC: Laboratory Corporation of America; December 2, 2014. https://www.labcorp.com/wps/wcm/connect/IntGeneticsLib/integratedgenetics/home/about+us/news+and+announcements/2013/labcorp+to+offer+brcassure+breast+cancer+mutation+tests.

4. Myriad and UnitedHeatlhcare sign three-year agreement making myRisk hereditary cancer test available to United members [press release]. Salt Lake City, UT: Globe Newswire; May 6, 2014. http://investor.myriad.com/releasedetail.cfm?ReleaseID=845492.

5. Gamble M. 153 statistics on dominant payers in each state. Becker’s Hospital Review website. http://www.beckershospitalreview.com/finance/153-statistics-on-dominant-payers-in-each-state. html. Published August 28, 2013. Accessed August 14, 2014.

6. State Health Benefits Program and School Employee Health Benefits Program. State of New Jersey website. http://www.state.nj.us/treasury/pensions/health-benefits.shtml. Accessed August 14, 2014.

7. LabCorp to offer FDA approved breast cancer prognostic test [press release]. Burlington, NC: Business Wire; January 13, 2014. http://www.businesswire.com/news/home/20140113005074/en/LabCorp-Offer-FDA-approved-Breast-Cancer-Prognostic#.U-zJirFCrPw.