Leading medical groups like the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the American College of Medical Genetics (ACMG) agree: non-invasive prenatal testing (NIPT) is the most accurate screening test for common chromosomal disorders and should be recommended for all pregnancies, regardless of risk level.
Fortunately, most major health insurance companies – including all twenty of the largest commercial payers in the country – now cover NIPT access for all expectant mothers. Unfortunately, there remain a few private health insurance companies, including the nation’s largest insurer UnitedHealthcare (UHC), that still impose unnecessary administrative hurdles like preauthorization requirements that inhibit timely NIPT access for pregnant women.
What are “preauthorization requirements” and how do they impact access to NIPT?
Preauthorization requirements call for physicians to obtain prior authorization (PA) for specific tests, procedures, or care such as NIPT. Private insurers like UHC often argue that the goal of these policies is to ensure genetic testing is performed for appropriate clinical indications. They also argue that PA requirements underscore the importance of counseling prior to these tests so that patients are informed about their risks, benefits, alternatives of each type of test for the individual, as well as other information. This argument falls apart, however, when one takes a closer look at which specific tests or procedures actually require PA from UHC. For example, UHC currently does not have PA requirements for standard quad screen serum testing – a test that has 19x higher false positive rates than NIPT. Wouldn’t it make more sense for counseling to be available to patients who receive less accurate prenatal testing options like quad screen serum testing than to those who receive newer, more accurate tests like NIPT?
Furthermore, as Stand Up for APA board member Brianna Wetherbe points out:
“Preauthorization requirements place additional burdens on physicians and their staff, negatively impacting access to genetic testing. A 2020 American Medical Association physician survey found that 94% of expert respondents agreed that preauthorization requirements delay their patients’ access to necessary care, and 79% agreed this can sometimes lead to abandoning treatment.”
While prior authorizations may understandably be required for extremely expensive medications or procedures like PET scans and MRIs, NIPT is already considered by most physicians as the standard of care.
It’s time for UnitedHealthcare to remove these PA requirements around NIPT for all pregnant women.