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Tuesday, May 21, 2013

Does Insurance Cover BRCA Genetic Testing?

Last week’s op-ed piece by Angelina Jolie has brought to the forefront BRCA testing, and choices women make regarding their BRCA status and preventative measures against breast and ovarian cancer.

It also raises the question: Is BRCA testing only for men and women who are of means? Who can afford genetic testing for BRCA?

Is BRCA testing covered by insurance?

BRCA testing is usually covered by insurance if the patient meets certain criteria. There are different types of BRCA testing, ranging in cost from $475 to $4000. Genetic counselors are helpful in determining what type of testing is indicated. Testing is less expensive once a mutation has been identified within a family.

Insurance coverage and criteria varies by insurance plan, and genetic counselors are excellent at determining whether insurance is likely to cover the testing. Insurances more readily cover testing of people with a personal history of cancer and ideally, testing in a family starts in an individual who has had a BRCA-related cancer at a young age.

This first person to undergo testing in the family has complete sequencing of both the BRCA1 and BRCA2 genes. This costs about $3300 and if no mutation is found, an additional $700 test looking even more closely at both genes may be necessary. For individuals of Jewish ancestry, a simpler test can often be performed that looks at just the common BRCA mutations within that population, for a cost of $575. Lastly, once an individual in a family test positive, other family members typically only require testing for a single mutation which is a simpler test that costs about $475.

There are also options for individuals who lack insurance coverage of genetic testing. Uninsured individuals may be eligible for free testing via the laboratory. Under-insured individuals can apply for financial assistance through an organization called Cancer1Source and depending on where they are tested, may have access to institutional earmarked charity funds.

Another insurance question that often arises is whether a positive result will make it harder for an individual to get health insurance. Legislation passed in 2008 bars discrimination based on genetic test results for the majority of health insurance companies and plans. This legislation extends to protect people from discrimination based on genetic test results in the realm of employment. It is important to note that no such protections are in place for things like life and long-term disability insurance, so some consider putting these in place before testing is performed.

Learn more about BRCA testing at the Basser Research Center for BRCA.

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