United Health Care’s Genetic Testing: Includes More Than You’d Think

Today’s Managing Health Care Costs Indicator is $25 billion

That’s the upper end of what a new white paper from United Health Care says genetic testing might cost in 2021.  The UHC data shows that the insurance giant spent $500 billion on genetic testing in 2010. 

I was pretty shocked when I saw that Medicaid beneficiaries had a higher rate of genetic testing than those with commercial (employer sponsored) insurance or those on Medicare.  Huh?   Does it make sense that an insurance plan focused on economically-disadvantaged young moms, the disabled who often suffer from major mental illness and long-time nursing home residents would have the highest rate of genetic testing? 

Only if the definition of genetic testing is expansive.  A genetic test here is defined as any test that uses genetics to get an answer. The overwhelming majority of tests are likely laboratory studies to rule out sexually transmitted disease (chlamydia, gonorrhea, and HIV).  Those tests aren’t nearly as expensive * as the tests of an individual’s genome to detect heritable diseases, or the tests of a cancer’s genome to determine susceptibility to a chemotherapy agent.  They often replace non-genetic tests that took longer, required more difficult sample-gathering, or were less accurate.  

I think it’s more valuable to focus on the more expensive genetic tests that are being used to personalize medicine – and consider the tests for sexually transmitted disease (not highly individualized) just as we treat other diagnostic tests.

Click images to enlarge. Source 

UHC’s recommendations on how to approach genetic testing from a policy perspective make sense to me. The recommendations are on pages 5 and 6; I’ve rephrased them

- Insure confidentiality
- Do comparative effectiveness research 
- Pay for the actual value of a test (rather than an inflated initial amount with upward adjustments) 
- Transparent coding and reporting
- Better regulation of lab companies doing genetic tests – especially “laboratory developed tests,” which right now the white paper says have “minimal oversight.” 
- Train doctors and health professionals so that they can give accurate (and good) advice

* Note you can purchase 20-pack tests for chlamydia for about $20 per test.