Once any mutation is identified, a test can be made available within one to two years. Some health plans may be prepared. We would do it aggressively and proactively, particularly if the disease is preventable. Although genetically informed prevention strategies promise real savings in both lives and dollars, it is uncertain who will lead the charge - it could be employers or individual consumers. And getting at-risk populations to remain on genetic therapies will require better approaches to compliance than are currently available to be successful.
Some genetic services are routinely covered benefits.
Engaging the medical genetics community in technology assessment and guideline development as part of the benefit determination process could help health plans avoid a costly administrative crunch as requests for coverage or appeals of denied services increase. Trained in both human genetics and medicine, medical geneticists can help translate the implications of new genetic knowledge for better patient education and care. By including medical geneticists on technology assessment committees, engaging the American College of Medical Genetics in reviewing guidelines, and building affiliations with academic programs in medical genetics, health plans can send a powerful signal to both consumers and biotechnology companies that safeguards and standards have been developed and implemented. The volume of new tests and treatments needing review will certainly increase and requires process reengineering. All the executives surveyed agree - health plans will play a critical role in ensuring the confidentiality of member genetic information.