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Genetic tests for inherited mutations for treatment selection
Any person diagnosed with pancreatic cancer meets national guidelines for genetic testing for an . Genetic testing may be used to guide treatment selection.
- People who test positive for an inherited or mutation may respond better to a treatment regimen that includes a type of chemotherapy known as platinum. They may also benefit from with a type of known as a .
- People who test positive for other inherited gene mutations may qualify for clinical trials looking at targeted therapies.
- People who test positive for a gene mutation may benefit from treatment with an agent.
testing for treatment selection
tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:
- how fast the cancer is growing
- which treatments are most likely to work
- whether or not the cancer is responding to treatment or growing
- whether or not the cancer has come back after remission
tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. tests used to select a specific treatment are sometimes called "companion diagnostic tests." These tests may be done on tumor tissue or (in many cases) on blood. See our Testing section for more information.
Examples of tests used in pancreatic cancer include:
- Some pancreatic cancers will have an abnormality known as MSI-H (“ high") also known as "" ( or ). MSI-H cancers are common in people with a gene mutation. These cancers may respond well to a type of treatment known as an immune checkpoint inhibitor. One example of an agent used for cancers is Keytruda (pembrolizumab).
- Some cancers have a specific genetic change called an NTRK fusion, which can be found on tumor testing. People whose tumor test reveals an NTRK fusion may benefit from the Vitrakvi (larotrectinib).
- Additional tests may help identify people who are elegible for certain clinical trials.
Paying For Care
Paying for testing
Insurance companies are required to cover the costs for cancer treatment. Health plans may vary on the amount of out-of-pocket costs and coverage for specific doctors, facilities, tests or treatments. Your doctor's office and treating hospital should disclose how much your treatment may cost you and work with you on a plan to cover the cost of your care.
Medicare will cover the cost for genetic testing and testing for people who meet certain criteria. Medicare coverage varies based on where you live. Visit this site to find and contact your regional Medicare provider for more information about coverage. The Medicaid website has a link to state Medicaid programs, which list specific eligibility for each state.
If you need information about finding an insurance plan, watch our video: Choosing Wisely: How to Pick Insurance Plans.Visit our Health Insurance Appeals page for additional information on insurance appeals.
Some laboratories have assistance programs that help cover the cost for tumor testing:
- Caris Tumor Profiling Financial Assistance Form
- Foundation Medicine Billing and Financial Assistance
- Myriad Cares
- Tempus Billing and Financial FAQs
Organizations that offer co-pay assistance:
Other resources:
- The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs.
- Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.
Paying For Care
Insurance coverage for genetic counseling and testing
Most health plans cover genetic counseling and testing for inherited gene mutations linked to cancer in people who meet the national guidelines. The cost of testing and your out-of-pocket charges may vary based on several factors.
People who are denied coverage for genetic testing can file an appeal (FORCE has sample appeal letters). Your healthcare provider can work with your insurance company and help you file an appeal if needed. Low cost testing may be available for $250 or less. Learn more about coverage for genetic counseling and testing here.
If you need information about finding an insurance plan, watch our video: Choosing Wisely: How to Pick Insurance Plans.
testing under the Affordable Care Act
Under the Affordable Care Act (ACA), insurance companies must pay for both genetic counseling and testing with no out-of-pocket costs for women who meet certain criteria. The ACA regulations are limited to testing for and only and do not cover genetic counseling or testing in all situations. You can learn more about testing under the ACA here.
Medicare and Medicaid coverage of genetic testing
Genetic counseling and testing is typically covered by Medicare for people already diagnosed with cancer who are in treatment or for whom test results may affect their care. Most state Medicaid programs cover genetic testing for and mutations for people who meet requirements, which vary by state. You can read more about Medicare and Medicaid coverage of genetic testing here.
Financial assistance or low cost genetic testing
JScreen is a national program based out of Emory University that provides low-cost at-home genetic counseling and testing with financial assistance available. Many laboratories offer low-cost genetic testing or financial assistance programs. Programs vary, so if you are not eligible for assistance through one lab, consider contacting other labs to see if you qualify .