How Can Patients Combat the Cost of Sophisticated Blood Tests?

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Andrew Schorr:

We got a question in though for you, Dr. Schilsky, from Darrell.  We were talking about genomic testing to understand what version of a disease we have either because of our ethnic background or some other thing that's going on with us.  As you know, insurance companies for a while have been balking at some of these more sophisticated tests, yet we and our doctor need that for us to get what may be right on target for us.  So maybe you could talk about work that ASCO's doing at all related to that.  We want the testing done, but we also want to get it paid for so we can get that right, precise care. 

Dr. Schilsky:

Yeah.  It's a complicated question because the testing is done at different points in the person's illness.  And so typically a test on a tumor specimen that's necessary to determine a standard of care treatment, and many of these tests are referred to as companion diagnostic tests.  Those tests typically are covered by insurance because the treatments themselves are also covered by insurance and the only way to know if you can get the treatment is to have the test done. 

Now, where it gets a little bit uncertain is when you get into this sort of large-scale genomic testing where a patient's tumor might be tested for many hundreds of genes not really knowing what you're looking for and not really knowing what you're going to do when you find it.  And that is where you're beginning to bump up a little bit against, research and that's where the insurance companies, sometimes some are reluctant to pay for that kind of testing. 

Now, at least one of those large genomic profiling tests earlier this year was approved by both the FDA and Medicare and now will be reimbursed.  So that's the good news, and I think that's the direction that most insurance companies are heading in. 

One of the things that my organization is doing to try to understand how best to use these tests and how best to use targeted cancer drugs is we're doing our own clinical trial that's available in 20 states around the country, so not the entire country yet, but has already enrolled more than 1200 people on the study over the last two-and-a-half years.  And we're doing this study to understand how this kind of genomic testing is done, what kind of treatment is recommended based on the results of the genomic test and whether or not that treatment actually works.  

Andrew Schorr:

Cecelia, you mentioned earlier about the lady walked into the health fair and when you started talking to her about trials she said I got to go to work, and she walked out.  And Dr. Schilsky was talking about eligibility requirements, but there are other issues where the study may be asking you to come back to some place or have multiple tests with some frequency, so it's not just leaving work one time.  It may be leaving work 20 times.  Have you had people voice that concern to you, that it's just—what's being requested is just too much?  

Cecelia Mann:

Yes.  I think the lack of convenience for people who don't have the funds or don't search out the funds would definitely hinder them being on a clinical trial or being open to hear about the clinical trial.  So, yeah, convenience and awareness.  We try to spread awareness that, yes, after we talk about the disease, the myeloma and the symptoms then we go into the resources. And, you know, I make sure I tell them about calling the information line and talking to the master’s level oncologist professional there and finding out about the latest trials, the latest treatments in addition to what they're doing currently with their doctors or their family members or friend that is diagnosed with one of the blood cancers.  

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.