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ACOG Objects to Insurers' Genetic Counseling Requirements for BRCA Testing

NEW YORK (GenomeWeb) – By placing coverage conditions on BRCA genetic testing, insurers are restricting obstetrician-gynecologists' ability to order tests, and hindering patient access, two professional medical groups warned in a joint statement.

The American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists, together known as ACOG, issued a statement that insurers' prior authorization requirements will make it harder for women to get the care they need. "ACOG opposes such attempts to restrict the scope of practice of obstetrician-gynecologists, who are fully qualified to provide pre-test counseling to their patients," the groups said in their statement.

Starting Jan 1, UnitedHealthcare is expected to begin requiring genetic counseling for coverage of BRCA testing. Other insurers may issue similar coverage policies. The policies come with the increasing availability and growing demand for next-generation sequencing-based panels gauging multiple genetic markers at once. 

Some insurers have raised concerns about the utility of such tests, because they gauge a range of markers with varying levels of evidence. The Centers for Medicare & Medicaid Services for example, issued a draft local coverage determination (LCD) in May proposing to cover BRCA testing as part of NGS panels when independent pre- and post-test counseling is provided, the genes on the panel are relevant to the personal and family history of the person being tested, BRCA testing criteria outlined by CMS are met, and the person meets professional guidelines for being tested for at least one other hereditary cancer syndrome, such as Lynch syndrome.

"Large panels with genes that are not relevant to the individual's personal and family history are not reasonable and necessary," CMS noted in the draft LCD.

However, ACOG objects to such restrictions and asserts that ob/gyns are skilled in evaluating a woman's medical and family history, providing pre- and post-test counseling, and ordering genetic testing when appropriate. Moreover, the groups pointed out that given the limited number of genetic counselors in the country, it would be particularly difficult for women in remote locations to meet insurers' prior authorization requirements, which could result in treatment delays.

"Imposing non-medically necessary prior authorization requirements that block a woman's trusted physician from ordering appropriate care for patients is contradictory to quality medical care, and is bad medicine," ACOG President Mark DeFrancesco said in a statement.

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