Cigna to require genetic counseling before some gene tests
The Bloomfield, Conn., insurer is the first major insurance carrier in the nation to adopt such a policy, which takes effect Sept. 16.
A patient who has Cigna insurance now would consult a doctor before getting gene testing, such as a test for the BRCA1 or BRCA2 genes related to breast and ovarian cancers. The doctor would send data on the patient's personal history and family history of cancer, and Cigna would decide whether to allow the genetic testing.
In that process, the patient doesn't learn why a test is approved or rejected. The new policy to require genetic counseling allows the patient to understand genetic testing better, an approach that's embraced by more and more national medical societies, said David Finley, national medical officer for enterprise affordability and policy at Cigna Corp.
"These tests are coming at a fast and furious rate," Finley said. "They have a lot of implications for patients and their families and they are hard to understand. It's a new field."
Tens of thousands of Cigna's customers have received genetic testing, which is a new and evolving field. The most extensive testing can cost between $3,000 and $4,000, though other tests can be about $600. Cigna, however, expects that the money it will save from fewer people getting tests will break even with a greater cost to provide genetic counseling, Finley said.
Cigna has contracted with InformedDNA, a genetic testing and counseling business in St. Petersburg, Fla.
"Our approach increases access to genetics specialists who have the training to ensure that every person seeking information about their genetic makeup and health risks receives the best and most personalized information available to get the most appropriate care," InformedDNA CEO David Nixon said in a prepared statement.
Dr. Otis Brawley, chief medical officer of the American Cancer Society, said Cigna's move is the right one.
"What Cigna's doing is what everybody ought to do," he said. "We have a large number of women who are concerned that they have a mutation that puts them at risk of breast cancer, and a very small percent of them who actually do."
In recent years, Brawley said, he has received calls from women who learned that they have genetic mutations of "unknown significance." Panicked, they get a double mastectomy. Sometimes, scientific advances later reveal that those same mutations posed no increased risk.
The recent publicity about Angelina Jolie's double mastectomy has also led to an increase in women concerned about the BRCA1 and BRCA2 genes. Jolie had the two genes, which increased her risk of breast cancer by 85 percent, Brawley said. But the news of it has caused many women to focus on the BRCA genes exclusively and ignore other risk factors. Besides the two BRCA genes, there are three genetic mutations strongly linked to increased risk of breast cancer.
"Because of Angelina Jolie, you have people with the other three mutations going to get tested for BRCA1 and BRCA2, because they've heard of them," he said.
A genetic counselor, he said, can go through a patient's family history of disease and determine whether there is cause to test for BRCA1 and BRCA2. What patients might find instead, he said, is that they should be tested for other mutations. For instance, a family with a history not only of breast cancer but of sarcomas and leukemia would suggest a greater risk of Li-Fraumeni syndrome, a hereditary disorder with a close link to breast cancer.
Another benefit to getting counseling is cost. If a patient knows that he or she is at risk for a specific gene, Brawley said, a test that focuses solely on that one gene costs only about $400.
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