- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
A Glimpse Into Managed Care of Diagnostics
Leaders at New Jersey’s major academic research institutions are enthusiastic about the role that genetics and precision medicine will play in cancer care. However, which genetic and
diagnostic tests gain ground in the market may not be up to oncologists and researchers.
This summer, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) removed Myriad Genetics from its network, becoming the first major carrier to change network status, according to Myriad spokesman Ronald Rogers. Instead, Horizon will coordinate all genetic testing through its in-house laboratory, LabCorp, which has formed a specialty testing group, Integrated Genetics.1 In December, less than 6 months after the US Supreme Court ruling that ended Myriad’s monopoly on BRCA testing,2 Integrated Genetics announced a new national BRCA testing suite called BRCAssure.3
Thomas Vincz, a spokesman for Horizon BCBSNJ, said in an e-mail to Evidence-Based Oncology that Horizon’s longstanding relationship with LabCorp will allow its members to pay
less for services by using an in-network provider, and that, “Horizon believes LabCorp’s BRCA testing is equivalent to testing by Myriad Genetics.”
Myriad, meanwhile, during its fourth-quarter earnings call August 12, 2014, strongly maintained the position that its testing quality and customer service are superior to competitors, based on the experience gained from testing 1.3 million patients. Elsewhere in the market, Myriad has reached relationships with other insurers, notably UnitedHealthcare, to offer its myRisk test to patients.4
But in New Jersey, the Horizon decision is both a financial and policy blow. Not only does Horizon BCBSNJ have 54% market share and 592,630 enrollees,5 but Horizon is a longtime administrator of the self-funded State Health Benefits Program, which covers thousands of public employees and retirees and, this being New Jersey, many lawmakers themselves.6
Of note, Horizon’s relationship with LabCorp does not extend to all tests that LabCorp administers. In January, LabCorp announced the launch of Prosigna, the breast cancer prognostic gene assay from NanoString, which has FDA clearance.7 According to Vincz, Horizon still considers Prosigna an “investigational” assay, and consistent with national policy for the Blues affiliates, it is “not currently a covered benefit for Horizon BCBSNJ members.”References
1. Integrated Genetics. LabCorp Specialty Testing Group website. https://www.labcorp.com/wps/wcm/connect/intgeneticslib/IntegratedGenetics/Home/About+Us/About+Us. Accessed August 14, 2014.
2. Munro D. Supreme Court breaks Myriad monopoly. Forbes website. http://www.forbes.com/sites/danmunro/2013/06/16/supreme-court-breaks-myriad-monopoly/. Published June 16, 2013. Accessed August 14, 2014.
3. LabCorp to offer BRCAssure breast cancer mutation tests [press release]. Burlington, NC: Laboratory Corporation of America; December 2, 2014. https://www.labcorp.com/wps/wcm/connect/IntGeneticsLib/integratedgenetics/home/about+us/news+and+announcements/2013/labcorp+to+offer+brcassure+breast+cancer+mutation+tests.
4. Myriad and UnitedHeatlhcare sign three-year agreement making myRisk hereditary cancer test available to United members [press release]. Salt Lake City, UT: Globe Newswire; May 6, 2014. http://investor.myriad.com/releasedetail.cfm?ReleaseID=845492.
5. Gamble M. 153 statistics on dominant payers in each state. Becker’s Hospital Review website. http://www.beckershospitalreview.com/finance/153-statistics-on-dominant-payers-in-each-state. html. Published August 28, 2013. Accessed August 14, 2014.
6. State Health Benefits Program and School Employee Health Benefits Program. State of New Jersey website. http://www.state.nj.us/treasury/pensions/health-benefits.shtml. Accessed August 14, 2014.
7. LabCorp to offer FDA approved breast cancer prognostic test [press release]. Burlington, NC: Business Wire; January 13, 2014. http://www.businesswire.com/news/home/20140113005074/en/LabCorp-Offer-FDA-approved-Breast-Cancer-Prognostic#.U-zJirFCrPw.
High-Risk Care Management Impact on Medicaid ACO Utilization and Spending
July 10th 2025In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.
Read More
Corticosteroid Premedication for Infliximab Remains Unnecessarily Common
July 8th 2025Although use of corticosteroid premedication prior to infliximab infusions is declining, it remains unnecessarily high despite limited benefit and the risk of serious adverse events from corticosteroids.
Read More
Managed Care Reflections: A Q&A With David J. Shulkin, MD
July 7th 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The July issue features a conversation with David J. Shulkin, MD, a physician and former secretary of the US Department of Veterans Affairs.
Read More
Moving Evidence From Research to Practice: Q&A With Ken Cohen, MD
June 23rd 2025In 2025, each issue of Population Health, Equity & Outcomes will feature a profile of a health system leader transforming care in their area of expertise. This issue spotlights a conversation with Ken Cohen, MD, executive director of translational research at Optum Health.
Read More
