title: Impact of Payer Constraints on Access to Genetic Testing.
abstract: With increased demand for hereditary cancer genetic testing, some large national health-care insurance payers (LNHPs) have implemented policies to minimize inappropriate testing by mandating consultation with a geneticist or genetic counselor (GC). We hypothesized such a restriction would reduce access and appropriate testing.
  
  
  
  Test cancellation rates (ie, tests ordered that did not result in a reported test result), mutation-positive rates, and turnaround times for comprehensive BRCA1/2 testing for a study LNHP that implemented a GC-mandate policy were determined over the 12 months before and after policy implementation (excluding a 4-month transition period). Cancellation rates were evaluated based on the reason for cancellation, National Comprehensive Cancer Network testing criteria, and self-identified ancestry. A control LNHP was evaluated over the same period for comparison.
  
  
  
  The study LNHP cancellation rate increased from 13.3% to 42.1% ( P < .001) after policy implementation. This increase was also observed when only individuals who met National Comprehensive Cancer Network criteria for hereditary breast and ovarian cancer testing were considered (9.5% to 37.7%; P < .001). Cancellation rates increased after policy introduction for all ancestries; however, this was more pronounced among individuals of African or Latin American ancestry, for whom cancellation rates rose to 48.9% and 49.6%, respectively, compared with 33.9% for individuals of European ancestry. Over this same time period, control LNHP cancellation rates decreased or stayed the same for all subgroups.
  
  
  
  These findings demonstrate that a GC-mandate policy implemented by a LNHP substantially decreased access to appropriate genetic testing, disproportionately impacting minority populations without any evidence that inappropriate testing was decreased.
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Pat
authors.initials: P
authors.lastname: Whitworth
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Peter
authors.initials: P
authors.lastname: Beitsch
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Christopher
authors.initials: C
authors.lastname: Arnell
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Cox
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Krystal
authors.initials: K
authors.lastname: Brown
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: John
authors.initials: J
authors.lastname: Kidd
authors.affiliation: Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; and Myriad Genetic Laboratories, Inc., Salt Lake City, UT.
authors.forename: Johnathan M
authors.initials: JM
authors.lastname: Lancaster
mesh_terms: D005817:Genetic Counseling / Q000191:economics*; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D007341:Insurance / Q000191:economics*