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Anthem Blue Cross Launches Program to Ensure Appropriate Use of Genetic Tests

NEW YORK (GenomeWeb) – Anthem Blue Cross announced on Frdiay a program to promote "appropriate use" of genetic tests and improve the efficiency of prior authorizations.

The program, called Genetic Testing Solution, will be administered by specialty benefits manager AIM Specialty Health, and is aimed at promoting "appropriate use" and providing "education that addresses the clinical and financial complexities of genetic testing," Anthem Blue Cross said in a statement.

The health insurance industry has been debating how to manage a rapidly growing and increasingly complex genetic testing market, which currently offers 70,000 products and is forecast to be valued at $10.3 billion by 2024, according to Anthem. “Staying current with all the advances in genetic testing is really confounding for physicians,” Razia Hashmi, Anthem's medical director for commercial business, said in a statement.

UnitedHealthcare also announced recently that starting Oct. 1, it will implement a national online prior authorization program for genetic and molecular testing in the outpatient setting. The program applies to fully insured UnitedHealthcare commercial members. 

Anthem's program went live on July 1 among fully-insured and self-insured members. National account members will have access to the program in 2018.

Within this program, AIM Specialty Health will review testing requests and help labs, providers, and patients coordinate clinical decision making. Anthem expects that the Genetic Testing Solution will enable greater efficiency "by moving from a manual, labor-intensive, and post-service process to a real-time automated system that can deliver prior authorizations to doctors as they are sitting with their patients."

The Genetic Testing Solution, according to Anthem Blue Cross, may also reduce errors in filling out paperwork, as well as speed up the submission and processing of insurance claims for certain genetic tests "from days to minutes," as its prior authorization process will have specific CPT code information for the test performed.