BRCA Choices Not Affordable for Many US Women

Roxanne Nelson

May 23, 2013

In This Article

Perseverance and Ingenuity

Dr. MacDonald, however, is optimistic that with perseverance and ingenuity, many more people can have access to healthcare. With her colleagues, she runs a high-risk clinic at USC, where they offer a wide range of preventive options, including mammograms, MRIs, pelvic ultrasounds, medications, and surgical prophylaxis "if that's what patients choose."

"There is a hodgepodge of programs that we can get patients enrolled in," Dr. MacDonald said in an interview. "We get creative, and it is rare that we don't have something that we can offer high-risk women."

She explained that they have a 3-year grant from the Avon Foundation and that the Medicaid program in California (known as MediCal) will pay for BRCA testing for eligible patients. "So as the Affordable Care Act expands MediCal, we will be able to get more patients covered."

"So this is very much going to be a state-by-state issue as to how patients are covered under the Affordable Care Act," she added. "We are lucky in California that MediCal will cover BRCA testing for patients who really need it."

The MediCal model is set up so that women see a genetic counselor, but many patients cannot afford or lack access to one. In such cases, there are guidelines that are published by the American Congress of Obstetricians and Gynecologists (ACOG) and the NCCN that give very clear criteria as to who may benefit from testing, Dr. MacDonald explained. "If those patients have a primary care doctor and fall within the guidelines for testing, then their primary care doctor can order the test for them."

Dr. MacDonald emphasized that it is far better to involve a genetic counselor because it is a complicated process, but if that option is not available, then a physician can coordinate it. "MedicCal will cover, based on the NCCN guidelines," she noted.

She is optimistic that women in other parts of the country can also receive assistance. "It can be done," she said. "It required dedicated personal and outside money, and Avon was the fifth organization that we submitted our proposal to before someone gave us a chance. Anyone in LA County is eligible to join our program."

Dr. MacDonald points out that the women who are most likely to struggle are those in small rural areas, where access to care may already be problematic. It may be harder to find a physician who accepts Medicaid, because providers in these areas can be few and far between. It is also more difficult to access large academic medical centers, which often provide services at low cost or free of charge.

"Finding providers to take Medicaid is a problem and will continue to be, but it will hopefully get better," she noted, adding that under the ACA, more women may be able to obtain health insurance, which will open the door to more options.

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