Breast Cancer Genetic Testing Gets Covered by Health Care Reform

Genetic testing for breast cancer will be covered under the Affordable Care Act, potentially saving women who need the test thousands of dollars.

Today (March 6), Myriad Genetics, the company that makes the test for the breast cancer genes BRCA1 and BRCA2, said that the U.S. government considers these tests to be preventive services. This means that private insurance plans are required to cover the cost of the tests, including co-pays, deductibles and coinsurance, provided that the plans do not have a “grandfathered” status.

Women with mutations in the BRCA1 and BRCA2 genes are at higher risk for breast cancer and ovarian cancer compared with women who don’t have the mutated genes. The cost of  testing can range from $300 to $3,000, depending on how much of the genome is analyzed, according to Breastcancer.org, an organization that provides information on breast cancer.

Previously, the decision about whether or not to cover the test was left up to individual insurance companies.

To be eligible for coverage of the test under the Affordable Care Act, a woman needs to be considered at high risk for breast and/or ovarian cancer, typically as a result of having a family history of the diseases, and she must have an insurance plan that is not grandfathered.

Grandfathered insurance plans are those that existed on or before March, 23, 2010, the date the Affordable Care Act was enacted. In 2012, only about half of Americans who received health insurance from their employers were enrolled in grandfathered insurance plans, Myriad Genetics said.

“This is good news because we believe that women should have the best data available to determine their risk of breast cancer and make decisions about their treatment,” said Andrea Rader, a spokeswoman for Susan G. Komen for the Cure, a nonprofit organization that funds breast cancer research and advocates for patients.

Because the BRCA1/BRCA2 genetic test is expensive, having health insurance coverage with no cost to the patient “is of great benefit” to those who need the test, said Janet Coffman, a professor at the University of California, San Francisco, who researches health policy. However, Coffman noted that just 2 percent of women are recommended to get the test. The other 98 percent are not considered not to be at high enough risk to benefit from the test, she said.

Factors that put women at high risk for breast cancer, and would make them candidates for the test, include having two first degree relatives who have been diagnosed with breast cancer, with one developing the disease before age 50; or being of Ashkenazi Jewish heritage and having a first degree relative with breast or ovarian cancer, according to the U.S. Preventive Services Task Force.

Because it’s quite common for health insurance plans to change, over time, more people are expected to be in non-grandfathered plans, Coffman said.

Pass it on: Some women at risk for breast cancer may be able to have the cost of genetic screening for the condition covered under the Affordable Care Act.

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