Is Prior Genetic Counseling Necessary for BRCA Testing?

It is important that women that who demonstrate a higher risk of ovarian or breast cancer undergo genetic testing to verify whether they have BRCA1 or BRCA2 mutations. This testing empowers women to take control of their health care and make decisions that are best for them and their families. However, physicians and insurers generally have opposing views as to whether genetic counseling is necessary before BRCA testing is ordered.

An increasing number of insurers are refusing to pay for the genetic tests unless the patient has received counseling from a certified genetic counselor or a medical professional with similar training. Many physicians, however, view this requirement as an unnecessary barrier to the medical care many women may require. Let’s take a closer look at each side’s position.

Insurers Push for Genetic Counseling

Some insurers assert that receiving genetic counseling beforehand allows women to better understand the processes of the genetic tests. Insurance companies also state that genetic counseling can help reduce costs by ensuring women who possess a family history that does not indicate a cancer risk are not compelled to undergo expensive BRCA tests.

Although many insurers require genetic counseling before genetic tests can be ordered, the exact policy can differ for each company. For example, both Cigna and UnitedHealthcare require that women receive pre-test genetic counseling. In order to counsel patients covered by Cigna, physicians have to undergo training in cancer genetics to comply with the insurance company’s genetic counseling policy. UnitedHealthcare requires only that physician confirm that they are qualified to conduct genetic counseling.

What Do Physicians Think?

The American Congress of Obstetricians and Gynecologists put out a statement in December 2015 stating that it disagrees with pre-testing restrictions by insurers on the basis that the restrictions can prevent women from seeking the medical services they may need. The requirement is considered unnecessary as OB/GYNs routinely counsel their patients regarding hereditary cancers of the reproductive organs and provide any preliminary information to the patient in order for her to decide whether to undergo the testing. As licensed physicians, they are more than capable to conduct the service, according to ACOG.

Many OB/GYNs and other detractors of the pre-test counseling requirement also believe that it places an undue burden on the relatively low number of genetic counselors in the United States. If a patient undergoes the BRCA tests and the results are negative for mutations, genetic counseling is generally not required and her physician can explain the results. Genetic counseling should be focused instead on interpreting the results of BRCA tests that have tested positive for mutations so that the patient fully understands her results and can consider her medical options.

An insurer’s requirement for genetic counseling before BRCA testing can affect how you are able to serve your patients. If you would like to learn more about this or any other issue regarding women’s health, Perinatal Resource Inc., has the resources that can help you. Contact us to learn more about our webinars, audio courses and live conferences.