February 2010 NewsLetter,"Genetic Testing: An Ever-Evolving Health Field Raises Complex Coverage Issues"

Abstract

Since the 1990s, there has been explosive growth in both the number of genetic tests and the costs associated with them. As part of their constant efforts to manage their health plan costs, trustees of multiemployer health funds need to be aware of these developments so they can periodically revisit their plans' coverage for genetic testing to ensure that it has medical value. This NewsLetter presents an overview of the issues and options. 

Genetic testing is a type of medical test that identifies changes in chromosomes, genes or proteins and is used to find changes that are associated with inherited disorders. Several hundred genetic tests are currently in use. More genetic tests are being developed all the time.

The cost of genetic testing varies widely. There may also be coverage costs associated with positive genetic tests.

There are many situations where genetic tests can provide useful information. For example, the results of a genetic test can confirm or rule out a suspected genetic condition or help determine a person's chance of developing or not developing a genetic disorder. It is also important to note that the value of some genetic tests has not yet been established.

Genetic science is complex and its correct use in clinical practice is challenging for most clinicians. In light of the complexity, determining the coverage criteria for genetic testing is particularly difficult for insurers and trustees. Plan sponsors should get expert advice when determining their plan's coverage rules for genetic testing.

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