The complexity surrounding appropriate use of genetic tests becomes obvious very quickly. A UM team may have to dedicate a large percentage of its time and effort to genetic tests. A separate sub-committee for this may even be needed.
Who to Test
Clear policies should be in place regarding which family members need genetic testing, and when. If such policies are not outlined, testing may be performed unnecessarily or prematurely. Also, most insurance companies do not allow testing to be done on non-covered family members. Here are three potential scenarios.
- A patient is tested for a certain inherited genetic disease. If the test confirms that the patient is a carrier, or has the disease, the question of whether the offspring has the disease becomes important.
- An individual wants to know if he/she has an inherited mutation in a susceptibility gene that puts the individual at risk for developing a certain disease. The individual cannot afford the test (eg, BRCA testing for breast cancer), but his/her parents can either afford to be tested or their insurance covers the test. Therefore the individual requests they be tested, knowing that if one or both parents are negative, the individual's risk of developing the disease is reduced.
- Parents are concerned that their child may have inherited a disease and want genetic testing performed. However, the disease does not manifest itself in childhood.
The UM team can create policies around formulary genetic tests such as "No formulary genetic test can be ordered without first getting a consult from genetics," or "Any genetic test >$500 requires that it be ordered or screened by a genetic counselor."