A recent article published in Managed Care highlights the flood of new diagnostic forces and why insurers are starting to ramp up prior authorization and utilization review. Today’s torrent of information around genetic and molecular markers for disease has outstripped the ability of physicians, health plans, and patients to know exactly what every new test means. Sometimes clinical labs introduce up to 10 new genetic lab tests per week. This number means that many plans are deciding to adopt prior authorization for genetic tests.
Hiring utilization management vendors is one way that health plans are seeking to control the ballooning cost of genetic and molecular testing. The complexity of such tests involves much more than a yes-or-no answer, says Lon Castle, MD, chief of molecular genetics and personalized medicine at eviCore healthcare. Genetic and molecular testing is the fastest growing segment of the lab market, and Castle says the best estimates are that it will generate $11 billion in sales this year for lab companies “and that’s just molecular and genetic tests.”