Dr Lee Schwartzberg Outlines Challenges With Accessing Multigene Testing in the Community Setting

May 7, 2019

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, explains reimbursement challenges that community settings face with access to multigene testing.

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, explains reimbursement challenges that community settings face with access to multigene testing.

Transcript

From a reimbursement standpoint, are there challenges with providing access to multigene testing in the community setting?

One of the problems with genetic testing is that many of the insurers have very rigorous policies about how they’ll allow testing, and that’s really restricted testing. In some cases even, large insurers have demanded that a genetic counselor do a consult. My own practice has been very fortunate to have genetic counselors for over 20 years, and they are wonderful, but they can be overwhelmed with the amount of patients. So, if we’re going to expand the criteria, then we have to have the insurance say we’re going to pay for this and we also have to have new delivery models of how people get tested and how they’re explained what the results of those testing are. One of the things about genetic testing that’s different than traditional taking care of patients is you’re not just talking about the person whose being tested because it has implications for the family. And so, you have to think more broadly of how are we going to get more people in to test, what is their decision making, how do we inform them on it, and there are issues there of expanded insurance.