How insurance impacts access to NIPT

Across the United States, including Wisconsin where the study was conducted, “many private insurances do not cover initial NIPT for low-risk women, creating a potential financial burden that may limit patient selection of NIPT,” wrote the authors, of whom four of the five are from the School of Medicine and Public Health at the University of Wisconsin in Madison.

The authors noted that low-risk women with public insurance in Wisconsin are covered for NIPT.

The study comprised the patient records of 1,006 women who received genetic counseling services during the 2018 calendar year at UnityPoint Health-Meriter, a University of Wisconsin-affiliated hospital in Madison, which is the largest delivering hospital in the state.

Women selected either NIPT or first trimester screening (FTS).

Women with public insurance were 3.43 times more likely to have NIPT as an initial screen for aneuploidy than women with private insurance.

Self-pay prices for NIPT can range from $299 to $349, according to the authors, with list prices between $1,100 and $1,590. “Some laboratories offer financial assistance and lower patient self-pay prices compared to the list price, which may be affordable for some,” they wrote. “For others, their self-pay prices could still present a barrier to equitable care between women with private insurance and women with public insurance.”

Despite a 2016 statement by the American College of Obstetrics and Gynecology (AGOC) that NIPT can be offered to the general obstetric population because it has similar sensitivity and specificity to the high-risk population, many private insurance companies still use the 2012 ACOG guidelines for determining insurance coverage for NIPT.

In contrast, in Wisconsin, low-risk women with public insurance like Medicaid do not pay for NIPT ordered by their provider, so declining the test is likely due to personal values.

Education, race or ethnicity was not a factor in determining whether NIPT was selected by a patient in either insurance group.

Study findings also indicate that more genetic counselors would recommend NIPT to patients if insurance coverage was not a financial barrier.

They were also more likely to discuss financial risks associated with NIPT when a patient had private insurance: 82% vs. 53% for public insurance. Thus, patients may be more aware of the cost and perhaps feel that genetic counselors are warning them of the price of the test.

Conversely, women with public insurance may not feel the same pressure or anxiety because the genetic counselors either do not discuss the cost or the cost is negligible because the patient will not receive a bill.

Regardless, a majority of genetic counselors agreed that a patient’s insurance coverage did not impact their counseling based on what testing choices were offered. But a major reason they feel it is necessary to discuss cost and insurance coverage is so that patients can make an informed decision.

Still, women with private insurance plans are “faced with the burden of costs associated with healthcare due to deductibles, co-insurance, co-pays, or lack of coverage for particular tests or indications,” wrote the authors. “If private insurance companies covered NIPT initially for the low-risk population of women, that could eliminate this disparity and allow women to choose a test that reflects their values.”

Source

Benoy ME, Iruretagoyena JI, Birkeland LE, Petty EM. The impact of insurance on equitable access to non-invasive prenatal screening (NIPT): private insurance may not pay. J Community Genet. 2021 Jan;12(1):185-197. doi:10.1007/s12687-020-00498-w