Affordable Care Act: BRCA Testing Coveredby PJ Hamel Patient Expert
Good news for many women considering genetic testing as the result of a family history of breast cancer: a clarification of "Obamacare" means most insurance plans will now cover the test.
Myriad Genetics, the company that administers the genetic tests many women undergo to determine if they're genetically at high risk for breast cancer, has announced that a clarification to the Affordable Care Act has ensured that such testing is covered by most insurance companies.
In the past, the high out-of-pocket cost for testing for mutations in the BRCA1 and BRCA2 genes prevented the test for many women who might otherwise have had it. BRCA testing can determine if a woman's risk of breast cancer goes beyond the normal 12% to upwards of 70%, in some cases. The test costs around $3,000.
The clarification, which comes from the U.S. Department of Health and Human Services, the U.S. Department of Labor, and the U.S. Department of the Treasury, "will allow for BRCA testing to be completed with no patient cost sharing for all non-grandfathered private insurance plans when an asymptomatic woman has a qualifying family history." (Gleason, 2013)
Women with a strong family history of breast and/or ovarian cancer are potential carriers of mutations in two genes, BRCA1 and BRCA2. If these genes are indeed mutated, the woman's risk of both breast and ovarian cancer can be so great that she might consider both prophylactic mastectomy and hysterectomy at an early age.
In fact, most physicians recommend that, to significantly reduce their cancer risk (up to 90% risk reduction), young women with these mutations undergo these preventive measures. And the sooner they're undertaken, the greater the risk reduction.
Clearly, this impacts a woman's reproductive life, creating a complex and stressful decision: do I act now to lower cancer risk, and never have children?
Or do I have children, knowing that by waiting I'm increasing my risk of both breast and ovarian cancer - as well as potentially putting those children at greatly increased risk for their own cancers, given the mutations are hereditary?
Fortunately, only a small percentage of American women carry these genetic mutations: less than 1%. And even for those already diagnosed with breast cancer, who might want genetic testing to determine if their children are at increased risk, the percentage is just 2.4%.
Still, the cancer risk is so great that if your doctor determines you fit the criteria to be tested, you should probably do it. And now that there's a much greater chance your insurance company will foot the $3,000 bill, the single biggest obstacle to obtaining that test has been removed.
Does breast or ovarian cancer run in your family? Do you feel you should be tested for a BRCA1 or BRCA2 mutation? Read our post, Is Genetic Testing Right For You, to find out if you're a likely candidate for testing.
Health reform covers breast cancer test . (2013, March 08). Retrieved from http://www.genomeweb.com/blog/health-reform-covers-breast-cancer-test
Gleason, S. (2013, March 06). BRCA testing granted preventive care designation under the affordable care act. Retrieved from http://globenewswire.com/news-release/2013/03/06/528521/10024193/en/BRCA-Testing-Granted-Preventive-Care-Designation-Under-the-Affordable-Care-Act.html