BRCA1/2 Testing in Massachusetts Among Women With Private Insurance or Medicaid, 2011–2015

Abstract

Purpose: Testing for BRCA1/2 mutations has increased among privately insured women in the United States. However, little is known about testing rates or trends among women with Medicaid. We sought to determine whether BRCA1/2 testing rates differed between women with private insurance compared with women with Medicaid in a state where both insurance types cover the test, and to compare testing trends from 2011 to 2015. Methods: We conducted a retrospective cohort study of medical claims from January 2011 through June 2015. We included Massachusetts women aged 18–64 with private insurance or Medicaid and at least 12 months of continuous enrollment. We used multivariable linear regression to examine the association of insurance type, age, and time with testing rates. Results: Mean monthly BRCA1/2 testing rates were lower among women with Medicaid compared with those with private insurance. Among privately insured women, mean monthly rates rose from 9.3 per 100,000 in 2011 to 18.4 per 100,000 in 2015, while among Medicaid-insured women, rates increased from 3.7 to 14.7. There was no difference in the monthly rate of increase in both groups (P=0.07). In adjusted analyses, rates were lower among Medicaid-insured women (7 fewer tests per month than privately insured women, P<0.001), and differed by age, with women aged 44–54 most likely to receive testing and women 18–34 the least likely. Conclusion: BRCA1/2 testing rates were lower among women insured by Medicaid compared with those with private insurance, though rates increased from 2011 to 2015 among both groups of women at a similar rate.

Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

“…Rhode Island’s Medicaid program focuses on BRCA coverage only for those in its managed care programs. A 2020 analysis of an all-payer claims database in Massachusetts noted an increase in mean monthly BRCA1/2 tests per 100,000 Medicaid-insured women from 3.7 in 2011 to 14.7 in 2015 [ 51 ]. On average, BRCA1/2 testing rates increased at a similar rate for both privately and Medicaid-insured women.…”

Statewide trends and factors associated with genetic testing for hereditary cancer risk in Arkansas 2013–2018

“…In comparison, Knerr et al reported a 33% increase in BRCA testing from 2005 to 2015 in women over 18 without an incident breast or ovarian cancer within their hospital system in Washington state [ 13 ]. Pace et al reported that in Massachusetts, the mean monthly number of tests per 100,000 women doubled to quadrupled from 2011 to 2015, depending on the type of insurance [ 14 ]. However, the absolute rates of testing for HCS in Arkansas remained low.…”

“…In multivariate exploratory models that controlled for key demographic differences, those with state employee coverage were 1.6 to 4.5 times more likely to receive genetic testing compared to commercial enrollees, while commercial enrollees were substantially more likely to receive any type of genetic testing than Medicaid enrollees. Type of coverage played a similarly important role in a study more narrowly focused on women receiving BRCA1/2 testing in Massachusetts; testing among privately insured women increased from 9.3 in 2011 to 18.4 in 2015, while among Medicaid enrollees, it increased from 3.7 in 2011 to 14.7 in 2015 [ 14 ].…”