Newsroom

May 02, 2019

Ambry Genetics Research Highlights Need for Expanded Genetic Testing Payer Coverage for Patients At-Risk for Hereditary Breast and Ovarian Cancer

Data presented at the 2019 American Society of Breast Surgeons (ASBrS) Annual Meeting

(Aliso Viejo, CA) May 2, 2019: Researchers from Ambry Genetics (Ambry), a leading clinical genetics testing company, will present results documenting discrepancies between U.S. insurer policies for genetic testing and the 2019 National Comprehensive Cancer Network (NCCN) medical management guidelines for patients at risk for hereditary breast and ovarian cancer (HBOC).  

Jill S. Dolinsky, Director of clinical affairs at Ambry Genetics, explained why this research is significant: “Multigene panel testing (MGPT) is now the preferred method for clinicians testing for HBOC because it enables adherence to the latest NCCN guidelines, which now include medical management recommendations for people with mutations in 16 different genes. Unfortunately, adoption of MGPT has outpaced insurance coverage. We felt there was a need to quantify how current insurance coverage guidelines impact patient access to testing and subsequent clinical management.”

Ambry assessed MGPT orders for patients insured by three major insurance carriers. Results revealed significant disparities among insurers as to the number and type of the 16 genes outlined in NCCN management guidelines covered. On a patient level, overlaying these results with NCCN management guidelines indicate that 25.6% of patients who should consider breast MRI screening and 10.5% of patients who should consider risk-reducing surgery for ovarian cancer would be missed if testing was limited to the genes covered under the insurance medical policies.

“On the patient level, the impact of these discrepancies is serious,” said Rob Guigley, Vice President of market access at Ambry Genetics. “In line with a limited number of the nation’s largest insurers, the data highlight the urgent need for payers to update their medical policy to be in step with the NCCN guidelines to ensure at-risk patients have access to HBOC genetic testing and can benefit from early detection and a potential reduction of their cancer risk.“

Presentation #581999 is being presented on Friday, May 3rd, 2019, 6:00-7:30 PM at the ASBrS Annual Meeting.