New policies adopted by some health plans are creating increased barriers to patient access to genetic screening services for women and their families. These new policies include pre-test genetic counseling requirements and prior authorizations for outpatient genetic and molecular lab tests, including preconception and prenatal genetic tests. In January 2018, the American College of Obstetricians and Gynecologists (ACOG) published a position statement opposing these new restrictions and their impact to women and their families, stating:
“Ordering of genetic testing should not be restricted by a requirement for pre-testing genetic counseling by a separate provider. ACOG opposes changes in pre-authorization policies and procedures that shift burdens to physician practices while potentially impeding women from undergoing timely indicated genetic testing.” Additionally, ACOG is “deeply concerned that these initiatives will prevent women from receiving needed care.”
Furthermore, in March 2018, the American Medical Association (AMA) published results of a 1,000-physician survey indicating that “more than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes.”
Please join us in supporting ACOG’s position and alerting health plans that women and their families deserve unhindered access to their important genetic information.
To: Medical policy directors at commercial and government health plans
The undersigned submits this petition to the receiving healthcare payer to request immediate reconsideration of required prior-authorization for all genetic tests, which negatively impacts practice workflow and the quality of healthcare that providers are able to provide to patients.
Statement of Grounds
In January 2018, the American College of Obstetricians and Gynecologists (ACOG), the industry-leading organization dedicated to the improvement of women’s health, released a position statement addressing barriers to accessing genetic testing. As noted, “Barriers proposed by health care insurers, including the Centers for Medicare and Medicaid Services (CMS), may impact women’s ability to receive genetic testing.” Such barriers include prior-authorization by healthcare providers prior to a patient accessing genetic screenings and tests, and the inclusion of lab benefit management companies who add another step to obtaining actionable health information.
As stated by ACOG, these barriers would “markedly limit access to genetic testing”, and although these policies “hope to ensure that genetic testing is performed for appropriate clinical indications, these requirements place additional burdens on physicians and their staff, negatively impacting access to genetic testing.”
The undersigned healthcare professional supports ACOG’s position to broaden access for genetic screening and reaffirms the organization’s concern that these initiatives will significantly reduce the number of patients who can benefit from the insights received as a result of genetic screening. Additionally, the undersigned reaffirms ACOG’s position and the conclusions of the American Medical Association physician survey that prior authorization puts healthcare providers under more strain while also potentially delaying patients from receiving actionable health information in a timely manner.
For the above reasons, the undersigned encourages all healthcare payers to support ACOG’s position statement and expand access genetic screening for all patients.