Fortunately, Angelina Jolie Isn't On Medicare

Margaret Dick Tocknell, May 22, 2013



Photo: Georges Biard / cc-by-sa-3

Most large private payers cover testing for a genetic marker indicating inherited breast cancer risk and will pay for prophylactic surgery. But Medicare has no national coverage decision for the test or for preventive mastectomy.

Last week 37-year-old Angelina Jolie, the actress, film director, and activist, kicked interest in genetic testing into overdrive when she announced that based on testing and her history of cancer, she had undergone a preventive double mastectomy.

A blood test showed that Jolie carries an inherited genetic mutation known as BRCA1, which increases her risk of developing breast and ovarian cancer. In a New York Times op-ed piece, Jolie wrote that the death of her mother at age 56 after a 10-year battle with cancer, combined with the BRCA results put her at an 87% risk of breast cancer and a 50% risk of ovarian cancer.

With the surgery she says her breast cancer risk factor is now less than 5%. She has opted to start with breast surgery, "as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex."  

Among my first thoughts after reading Jolie's column was how fortunate the mega-star was to be able to self-fund the testing as well as the procedure. A spate of news articles grumbled that BRCA testing, which carries a $3,000 price tag, is not typically covered by insurers.

A 2011 study of the public and private coverage policies for BRCA testing published by the National Center for Biotechnology Information, however, offers some evidence to the contrary: Private payers are doing a pretty good job of providing coverage.

Margaret Dick Tocknell Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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