DNA sequencing for cancer — not covered yet

What are the roadblocks to health insurers covering DNA sequencing of biopsied tumors as standard practice before cancer treatment?  Simple expense is an obvious one, but seems minimal in comparison to the savings from a better targeted treatment.  Do other roadblocks include a lack of expertise in utilizing the results of sequencing, a lack of medications targeted to certain mutations, or a lack of understanding by the insurers as to how coverage would work?  At what points do these roadblocks cease to exist?

Impatient Patient

Dear Impatient Patient,

Generally, health insurers do not cover services that are only used in clinical trials — which is the case for DNA sequencing of tumors.  It is not standard practice yet.  It may become standard practice as medications are invented (and approved by the FDA) to treat specific genomic mutations.  So, a medication that targets a mutation commonly found in a lung cancer would require a genomic sequencing before being prescribed.  At that point, the sequencing test might be covered along with the medication.  That is when the roadblocks would be overcome.  Until then, a patient does not have a medical need for the test and therefore, it is not covered.

If you are interested in being part of a clinical trial, you can visit ClinicalTrials.gov and search their directory.  You might qualify for a trial where these medications are being tested.  It’s worth a try!

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.