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Will My Insurance Pay for Gene Expression Profiling for My Myeloma?

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Published on November 16, 2016

Will you have to battle your insurance provider to get genetic profiling tests covered? Dr. Robert Orlowski of MD Anderson Cancer Center, and his colleague, Dr. Larry Anderson, Jr., of the University of Texas Southwestern Medical Center weigh in on this extremely important question. Dr. Anderson points out that most if not all insurances pay, at minimum, for the fluorescence in situ hybridization test that determines a patientâ??s level of risk. Dr. Orlowski goes on to explain where Medicare/Medicaid (CMS) and other insurance providers step up for gene expression profiling.

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Transcript | Will My Insurance Pay for Gene Expression Profiling for My Myeloma?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

I’ve got to ask you, and I'll address it to you first, Dr. Anderson. So this whole genetic sequencing, we patients want you to have the clearest picture of our myeloma so we get the right treatment, whether it’s standard treatment or even we could talk about a trial if it matches up with our situation. Insurance companies don’t always like to pay for that. So the whole cost of testing, let alone cost of treatment, comes into play. That’s sometimes a battle, isn’t it? 

Dr. Anderson:    

Yes, very much so, trying to get patient coverage for these tests can sometimes be an issue. But at least the standard tests like the fluorescence in situ hybridization is very key. I can’t imagine insurance turning down that one. And that, we really heavily rely on to determine if a patient is at high risk, or standard risk, or immediate risk and can help guide their therapy with that. 

Andrew Schorr:

Dr. Orlowski, do you have any comment about the need for genetic testing atthe outset for every patient?

Dr. Orlowski:     

The gene expression profiling which we’ve mentioned is something which is reimbursed by Medicaid and Medicare and several insurers. And there is now a pretty much consensus in the field that high-risk patients should be treated differently than standard risk patients. Within the cooperative groups—you mentioned SWOG, I think Larry is involved with ECOG, we have different studies for patients that are standard risk and those who are high risk, because the feeling is that the high-risk patients probably need more intensive and more continuous therapy than is the case for the patients with standard risks. 

So there should really not be too much of an issue getting the gene expression profiling done. 

Andrew Schorr:

Oh, good. All right, good news. But that leads to—you said it, and Larry you’d probably say it, too is this is why as you’re advancing your diagnostics and understandingdifferent groups within myeloma, that there should be some consultation with the myeloma specialist. So you understand—the patient understands their specific situation. You’ve got to get a clear picture.        

Dr. Anderson:    

Preferably the patient would need to see a myeloma specialist to get some input into what their therapy should be, or at least their physician should be consulting with one if their patient is not able to see one.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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