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Insurance will have to cover genetic testing kits in Illinois

A new law by former state Sen. Rachelle Crowe requires insurance companies to cover the cost of genetic testing kits. House Bill 5334 is effective Jan. 1, 2023.

“Early detection through genetic testing is essential for women with a family history of breast or ovarian cancers,” said Crowe, D-Glen Carbon. “By offering genetic testing at no cost, Illinois can offer comfort and stability to individuals who are at the most risk.”

According to the Centers for Disease Control and Prevention, the genes most commonly detected in hereditary breast and ovarian cancer are the BRCA1 and BRCA2 genes. About 3 percent of breast cancers, approximately 7,500 women per year, and 10 percent of ovarian cancers, an estimated 2,000 women per year, result from inherited mutations.

Once a test is recommended by a health-care provider, Crowe’s law requires insurance coverage for costs associated with genetic testing for the BRCA1 and 2 genes. The measure applies to Illinois residents with individual or group insurance policies issued on or after Jan. 1, 2024.

The Illinois Insurance code requires individual and group insurance health plans to cover annual cancer screenings for women who have tested positive for BRCA1 or 2 mutations. However, the code did not require health insurance plans to cover the gene mutation testing. Some insurance companies have specific genetic testing criteria or do not cover genetic testing in certain situations, even when considered medically necessary.

“By codifying the coverage into law, Illinois is creating a consistent, reliable process for genetic mutation testing for at-risk women,” Crowe said. “Hereditary breast and ovarian cancers pose significant threats to women’s health, and preventative medical treatment can be implemented once the risks are determined.”

 

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