Cigna Mandates Some Genetic Counseling, But Compulsory Referrals Still Rare

Insurance giant Cigna Corp. will soon require genetic counseling before covering some laboratory tests to determine the likelihood of an inherited medical condition—a shift in policy slow to take hold among payers, officials said. Starting in mid-September, Cigna will require enrollees who want to undergo testing for certain genetic disorders to undergo counseling first. The conditions include breast and colorectal cancer, as well as Long QT disorder, a genetic condition that can lead to an erratic heart rhythm and sometimes sudden death. The insurer believes as many as one-fourth of the tests it currently provides for these conditions may not be medically necessary. Cigna has retained the genetic counseling firm InformedDNA to perform the counseling. The Florida-based company will ask Cigna enrollees to submit to an online questionnaire, as well as an approximately one-hour interview with one of its 40 counselors prior to making a recommendation, according to David Nixon, InformedDNA’s chief executive officer. The counseling ranges in price from $100 to $300, depending on its complexity. By contrast, a BRCA test can run $3,000 or more. Nixon estimates that about one-third of Cigna enrollees who receive counseling will eventually undergo lab testing. He was unable to say whether the counseling will drive down the number of tests performed for Cigna’s enrollees. According to Nixon, other large insurers such as UnitedHealth and Aetna also provide genetic counseling, which was confirmed by officials with America’s Health Insurance Plans (AHIP), a trade group representing health carriers. But the primary difference is that Cigna is making such testing mandatory. “With the other carriers, it’s [just] strongly recommended,” said Nixon, whose company also works with those two other plans. Susan Pisano, a spokesperson with AHIP, noted that the Affordable Care Act requires insurers to cover BRCA testing for women considered at high risk for developing breast cancer—typically when other close relatives in one’s family contract the disease. While Pisano observed that the practice of insurers using genetic counseling is growing, they are doing so to sort out whether they should pay for tests that have high levels of false positives, or for which there is no treatment protocol should the patient test positive for developing a specific disease or disorder. Takeaway: Genetic counseling is becoming more widespread among health plans, but mandatory counseling is still rare.