As Raju mentioned in the previous entry, one goal of personalized medicine is to help minimize our country’s skyrocketing healthcare costs. Although this will be accomplished, in part, by using genetic information to improve a physician's ability to deliver targeted treatments to patients, another key component to this financial equation will be the education of insurance companies on how best to use personalized genetic medicine.

To highlight this point, take the case of a family who tragically lost a father from sudden cardiac death due to hypertrophic cardiomyopathy. Since HCM is one of the most commonly inherited cardiovascular diseases, the father’s close relatives, including his young son and daughter, are considered at risk for having inherited the disease. It’s important for the family to understand exactly what mechanisms contributed to the father’s death because this can help guide future healthcare decisions for his little boy and girl.

Although pricey at roughly $3000, tests for most of the genes known to cause HCM exist and insurance companies have demonstrated they will pay to have their patients tested. The standard procedure is to test the proband - or known affected family member - first, then if a genetic mutation is identified, all remaining family members can be tested for the known mutation at a fraction of the cost. In this scenario, the cost to test our father and his two children would be about $3500.

The problem is that the father in our scenario is dead and therefore no longer a patient of his insurance company. What happens now? Well, surprisingly, the insurance company pays a total of $6000 to have both the boy and girl tested for HCM. Let’s say the boy, but not the girl, is found to be positive for a mutation. Without knowing if the father carried this mutation and passed it on to his son, it can be challenging to interpret the significance of the mutation, and even more difficult to predict how this will affect the little boy’s health.

This is a simplified, yet real example of how insurance companies, if not properly educated, can contribute to the increasing cost of healthcare. To help solve this problem, physicians, geneticists, genetic counselors, and the insurance companies need to get together to discuss the most appropriate ways to obtain clinically relevant genetic information. Although this will be an ever evolving and ongoing conversation, patients, and the healthcare industry as a whole will most certainly benefit from these educational collaborations.