We can’t say we recall many instances of health insurers making a big show about what they’ll pay for twice. But Aetna put out an announcement today that says if there’s uncertainty about the accuracy of a test that breast-cancer patients get, the insurer will cover a do-over.
The test determines whether a patient’s tumor expresses an excess amount of a protein called HER2. If the test comes back positive, the patient may be a candidate for Genentech’s breast-cancer drug Herceptin, which targets HER2. But, as we pointed out early this year, the tests have sometimes proved unreliable. Some problems have to do with the labs’ technique; others have to do with how the results are interpreted by doctors.
Aetna isn’t making a big change to its benefits structure — it says its policy already allowed for re-dos — but the insurer is trying to draw more attention to the issue. “We are certainly trying to promote awareness of the problem, and if there is uncertainty, [then] repeat it,” Joanne Armstrong, head of Aetna’s genetics and women’s health programs, tells the Health Blog.
Aetna’s not alone. UnitedHealthcare put out a release in late 2006 that also pointed out the company pays for a second test. Lee Newcomer, SVP of oncology services at UnitedHealth, tells us there’s been a lack of consistency in how the test results are reported to doctors — which leads the docs to have trouble interpreting them. That’s improved, he adds, but the company remains concerned about labs’ technique, even in the wake of guidelines that the American Society of Clinical Oncology and the College of American Pathologists put out in late 2006.
Newcomer told us the company hasn’t seen a significant uptick in second tests, despite its announcement about its policy. UnitedHealth is sending 3,500 oncologists each a pound of coffee whose sales are tied to breast-cancer research, along with a written note about the issue.