Abstract
Hereditary breast and ovarian cancers (HBOCs) are common among the Latinx population, and risk testing is recommended using multi-gene hereditary cancer panels (HCPs). However, little is known about how payer reimbursement and out-of-pocket expenses impact provider ordering of HCP in the Latinx population. Our objective is to describe key challenges and possible solutions for HCP testing in the Latinx population. As part of a larger study, we conducted semi-structured interviews with key provider informants (genetic counselors, oncologist, nurse practitioner) from safety-net institutions in the San Francisco Bay Area. We used a deductive thematic analysis approach to summarize themes around challenges and possible solutions to facilitating HCP testing in Latinx patients. We found few financial barriers for HCP testing for the Latinx population due to laboratory patient assistance programs that cover testing at low or no cost to patients. However, we found potential challenges related to the sustainability of low-cost testing and out-of-pocket expenses for patients, access to cascade testing for family members, and pathogenic variants specific to Latinx. Providers questioned whether current laboratory payment programs that decrease barriers to testing are sustainable and suggested solutions for accessing cascade testing and ensuring variants specific to the Latinx population were included in testing. The use of laboratories with payment assistance programs reduces barriers to HCP testing among the US population; however, other barriers are present that may impact testing use in the Latinx population and must be addressed to ensure equitable access to HCP testing for this population.
Highlights
Next-generation sequencing allows for testing multiple genes in a single test
We identified three key themes that reflect challenges for hereditary cancer panels (HCPs) testing in the Latinx population: sustainability of lowcost testing and OOP to patients, access to cascade testing for family members, and choosing appropriate tests that include variants found in the population
There were no differences in OPP test costs for Latinx patients presenting for testing compared to nonLatinx patients
Summary
We address hereditary cancer panel (HCP) testing for hereditary breast and ovarian cancer (HBOC) in the Latinx population. Hereditary cancer testing is recommended to be conducted using multi-gene HCPs (NCCN 2021). Prior studies show that insurance coverage is variable and increasing for HCP (Trosman et al 2017), and there have been barriers to access reported for the Latinx population (Hurtado-de-Mendoza et al 2018; Cruz-Correa et al 2017). Medicaid expansion has increased coverage for genetic testing, but the impact this policy has had on access to testing in minority populations has not been studied. Little is known about how payer reimbursement and out-of-pocket (OOP) expenses impact provider ordering of HCP in the current clinical and reimbursement landscape, related to the Latinx population
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