Managed Care - February 2009 - (Page 22) “Oncologists are very aware of the OncotypeDX test,” says Cigna Medical OffiSizing up a growing market cer Doug Hadley, MD. Breast cancer spehe research and consulting firm Frost & Sullivan says that cialists in particular are likely to understand the U.S. market for FDA-approved genetic tests — not to the test, he adds. It identifies patients be confused with the direct-to-consumer genetic tests marmost likely to benefit from chemotherapy. keted by companies like 23andMe — hit about $200 million “We’re approving 95 percent of requests last year and is growing at the rate of 10 percent to 15 percent for that test.” a year. Worldwide, says clinical diagnostics research analyst Most physicians do not win high Kevin Leong, the number swells to $300 million. Frost & Sullimarks for the proper use of genetic tests van lists the top five genetic tests as: or for even a basic understanding of the 1. Cystic fibrosis: To identify the disease prenatally role of genetic counseling. 2. Her-2 status: To guide breast cancer therapy Armstrong cites one survey that shows 3. Warfarin metabolism: To guide dosage almost 3 in 4 physicians conceding only 4. Factor II and Factor V Leiden: To determine genetic risk a fair to poor understanding of the field. factors for hypercoagulability She’s not surprised. 5. HLA typing: To determine a likely immune response “I am an ob-gyn, and much new geSource: Frost & Sullivan netic testing was initiated in that specialty,” she adds. “I don’t know that I could practice now and use all the genetic tests appropriate for hereditary risk testing,” she says. available in an evidence-based way. They’re coming “They knew they were supposed to refer them for on the market at a very quick clip.” counseling, but they would order genetic tests anyTo get a better idea of how genetic information way, without counseling.” is handled by physicians, Aetna mounted a pilot Often without good reason. program for its employees. “We found that their experience in the health Insurers get engaged care system was inadequate,” says Armstrong. “Only By all accounts, the potential advantages offered 12 percent reported that they or someone in their by a bigger role for genetics in medicine are tremenfamily was advised to talk to someone trained in dous for all concerned. genetics.” Aetna says it will cover genetic counsel“The real value in pharmacogenomics is getting ing and testing provided the results lead to clinical the right drug to the right patient at the right time information that will help physicians direct a treatand then saving money,” says Louis Hochheiser, ment plan. Humana’s medical director of clinical policy deWith an explosion of new genetic tests available, velopment. “If we know that a drug works for some- T Plenty of evidence suggests that there is significant waste involved in genetic testing. says Shappell, it’s no wonder that doctors often don’t understand how to order tests and analyze the results. Physicians are also frequently unwilling to handle testing properly even when they do know what is required — a point that hit home when Shappell was doing genetic counseling at the Yale Cancer Center. “There were physicians that worked right down the street from us, knew we existed, knew that genetic counseling was available and that there were national guidelines that identified people who were body with cancer — even if it’s a drug that costs $100,000 a year — and we’re not going from one drug to the next, we’re going to save money in the long run. More important, people will get the benefit of this knowledge. We can determine which drugs are needed and start treating them right then. That could save days. They’re going to get less sick and get back to work. There are tremendous potential savings.” Realizing that potential, though, isn’t easy. A year ago, Humana had one policy on genetics. 22 MANAGED CARE / FEBRUARY 2009
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