News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Cigna to Preauthorize Genetic Tests

Clinical laboratories and pathology groups serving Cigna beneficiaries can expect to see new requirements for genetic tests used to diagnose breast cancer, colon cancer and long QT syndrome

Effective this week, Cigna (NYSE: CI) in Bloomfield, Connecticut, is implementing a new program that requires genetic counseling and pre-authorization for certain genetic tests. This is an important development and clinical laboratory executives can expect to see other health insurers take similar steps.

Cigna wants to control costs and improve the appropriateness of ordering expensive genetic tests. It will start with tests for three conditions and may require counseling for other types of genetic tests if this program is successful. Industry observers expect other health insurers will follow Cigna’s example and also require genetic counseling for a compelling reason: all insurers recognize that more than 50% of all genetic tests may be ordered inappropriately, experts say.

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Why Health Insurers Want to Pre-Authorize Genetic and Expensive Clinical Pathology Lab Tests

McKesson Corp. and MuirLab working to implement lab-friendly strategies to meet payer needs

Unfolding events make it likely that genetic testing will become a good news/bad news story for local clinical laboratories and pathology groups. The good news is that genetic tests and molecular assays will bring more diagnostic precision to patients and their physicians—and that points to an auspicious future for pathology and laboratory medicine.

The bad news is that payer requirements in the United States for pre-authorization of genetic tests may lock-out most local laboratories as providers for these specialized and important clinical laboratory tests. That’s the irony of this developing trend!

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