ASCO Opposes Expanded Cigna Policy on Cancer Genetic Testing | ASCO

ASCO Opposes Expanded Cigna Policy on Cancer Genetic Testing | ASCO

ASCO Opposes Expanded Cigna Policy on Cancer Genetic Testing

May 1, 2016

Cigna has announced plans to expand its policy that requires genetic counseling by a board-certified genetics specialist as a condition of coverage for genetic testing. First adopted in 2013 for breast, ovarian, and colorectal cancer, the expanded policy, which becomes effective July 15, 2016, will now apply to genetic testing for all hereditary cancers.

ASCO opposes this policy, which introduces an unnecessary barrier to the appropriate use of genetic testing services and has the potential to negatively impact care provided to patients with cancer. The policy prohibits patients from seeking this service from their physicians, unless they have been specifically credentialed by Cigna to perform pre- and post-test genetic counseling.

Under Cigna’s policy, Cigna members are required to receive pre-test and post-test counseling by either a board-certified genetic counselor or a clinical geneticist before coverage for a genetic test will be approved. Following pre-test counseling and a recommendation by the genetics specialist, final decisions on coverage of a genetic test will be made by a Cigna medical director.

ASCO believes the new Cigna policy inappropriately limits oncology providers’ ability to deliver high-quality and timely care to patients. Oncologists and oncology nurses are well qualified to provide counseling to patients before and after cancer-related genetic testing, and physicians are ultimately responsible for integrating testing into appropriate patient care. Many oncologists do refer patients to genetic counselors, and many cancer centers and practices have genetic counselors available. ASCO believes, however, that the care team and the patient should be able to decide who should deliver genetic counseling. Cigna’s requirement may result in patients opting out of genetic testing, even when testing is beneficial, because of the need for an additional referral. Ultimately, the policy is likely to increase costs by requiring unnecessary outside services that could normally be provided within the regular scope of oncology practice. 

Approximately 5% to 10% of cancers are attributable to a hereditary cancer predisposition syndrome. Identifying mutations in hereditary cancer risk genes such as BRCA1 and BRCA2 can provide long-term and potentially life-saving benefits for patients in early detection, prophylactic surgery, and choice of chemotherapy drugs—improving patient care and reducing overall health care costs for individuals and families. Identifying individuals who have an inherited cancer predisposition gene has significant benefit not only to patients, but also to at-risk relatives. As research in clinical cancer genetics advances, offering hereditary cancer risk assessment has become an expectation in oncology practice, and many oncologists now routinely provide testing for high penetrance alleles (i.e., BRCA 1, 2). Oncologists are optimally positioned to advise patients regarding the risk of second malignancies and treatment-related cancers. Germline risk assessment is regularly integrated into standard oncology practice.

The question of who should and should not be tested for inherited cancer susceptibility is of great significance for oncology providers and patients. ASCO’s updated genetic testing policyunderscores the importance of pre- and post-test counseling for individuals offered genetic testing for cancer risk. Cigna’s policy discounts the ability of appropriately trained oncology nurses and physicians to adhere to established guidelines and make proper recommendations for genetic counseling and testing, and it eliminates patients’ choice in obtaining information from the provider they wish.

ASCO has devoted considerable time and effort over the past two decades to establish high standards of quality for hereditary cancer genetic counseling and testing. Through policy statements, expert guidelines, and quality programs, ASCO has helped oncology professionals to responsibly integrate genetic counseling and testing into clinical oncology practice. Oncology providers have demonstrated their interest in, and commitment to, continuing education on this issue. Over the last two decades, ASCO has developed two editions of an educational curriculum, has held numerous workshops and symposia, and has fostered a growing number of online education modules on ASCO University. A comprehensive onlinegenetics toolkit serves as a repository of tools and resources to further assist oncology providers with hereditary risk management within their practices. These efforts alone have resulted in the education of more than 10,000 oncologists. 

Although Cigna was the first U.S. health insurer to impose this coverage restriction, several other private payers are now moving forward on similar policies. On the federal side, the Centers for Medicare & Medicaid Services (CMS) has adopted a policy that ensures that Medicare beneficiaries are able to receive genetic counseling from oncologists, a policy that ASCO played a significant role in shaping and that is in accordance with NCCN guidelines.

ASCO will continue to monitor the impact of the expanded Cigna policy on cancer care and provide additional updates at ASCO in Action. If you have questions or concerns about this policy and its potential impact on your oncology practice, please contact policy@asco.org.