No insurance coverage remains major barrier to genetic testing, may hurt medical management
Lack of insurance coverage remains a major barrier to patients wanting to undergo genetic testing, according to a study that analyzed clinical genetic testing insurance denial rates.
“A number of these patients have clinically diagnostic findings with medical management implications that would not have been identified without access to research testing,” the study authors wrote, noting a need for insurance carriers to re-evaluate their coverage policies.
Researchers analyzed 801 previous patients enrolled in a genomic research program. Overall, 18.3% (n = 147) had insurance prior-authorization denials, with exome sequencing and microarray testing the most frequently denied. Patients who had private insurance were also significantly more likely to be denied than patients who had public insurance.
More than half (53.7%) of the 147 patients with insurance denials had had ≥1 diagnostic or candidate finding, with 10.9% having a specific clinically diagnostic finding. Half of all patients with clinical diagnostic results had immediate changes to their medical management.
Zion TN, Berrios CD, Cohen ASA, et al. Insurance denials and diagnostic rates in a pediatric genomic research cohort. Genet Med. 2023;100020. doi: 10.1016/j.gim.2023.100020. Epub ahead of print. PMID: 36718845.