Boston-Area Plan Starts Covering 50-Cancer Detection Test

The company marketing the new Galleri cancer detection test is getting closer to making it a routine part of the life insurance underwriting backdrop.

The marketer, Grail, announced earlier this week that Point32Health, a large health plan, has agreed to test the Galleri test and see what happens.

Point32Health is the first commercial health plan to announce a Galleri test.

If Grail is correct about the Galleri test, it could revolutionize detection of dozens of types of cancer, including ovarian and pancreatic cancers, and lead to a sharp drop in cancer mortality, by helping doctors find and monitor cancers early, when the cancers are easy to control and treat.

The test could also shake up the life insurance underwriting process by giving patients critical information about their health that underwriters might not necessarily have.

Galleri, Grail and Illumina

The Galleri test searches the blood for “cell-free nucleic acids,” or scraps of cancer cell DNA and RNA. The test is not yet approved by the Food and Drug Administration, but trials show the test can detect about 50 different types of cancer, including ovarian cancer, pancreatic cancer and sarcoma.

Large Galleri trials are underway in both the United States and the United Kingdom.

Grail, the marketer of the Galleri test, is a Menlo Park, California-based arm of Illumina, a large genetic sequencing systems company.

Grail has already started selling Galleri tests, at $949 each, to U.S. patients who can pay for tests without using health insurance.

That compares with a list price of about $500 for providing and processing a home colon cancer test kit, and an average self-pay price of about $3,000 for a colonoscopy.

Illumina executives said earlier this month, on a conference call with securities analysts, that Grail generated $10 million in revenue in the fourth quarter from Galleri test fees and payments from organizations that want to prescribe the test.

Although Point32Health is the first commercial health plan that has announced a Galleri testing deal, many large employers and payers are interesting covering Galleri tests, the executives said.

Point32Health

Point32Health is the nonprofit, Canton, Massachusetts-based health plan formed by the merger of Tufts Health Plan and Harvard Community Health Plan.

It provides or administers health coverage for 2.2 million people in New England.

The Pilot Tests

Pilot32Health says it will start by giving the Galleri tests to employees who meet eligibility criteria, to see how the test works for them.

The carrier will then work with a health care provider group to give the test to patients out in the real world, to see how the test affects use of health care resources and patient-reported results.

An Open Question

One question about the test is whether it will detect important cancers that are easy to control or treat; detect important cancers that can’t easily be controlled or treated; or mostly detect, and lead to unnecessary treatment for, cancers that would have never posed a significant threat to a patient’s health.

If the test mainly leads to unnecessary treatments for unimportant cancers, it could cause more harm than good.

What It Means for Life Insurers

Life insurers could eventually use the Galleri test as part of their underwriting process.

If the Galleri test cuts cancer mortality, it could improve life insurers’ life insurance death benefits costs, by reducing the percentage of insureds who die from cancer.

If, however, many life applicants can get Galleri tests without giving life insurance underwriters the results, Galleri-related adverse selection could drive up life insurers’ claim costs.

Life insurers could fight Galleri-related anti-selection using the same weapons they use to fight applicant fraud, but it’s possible that laws, regulations and practical considerations would give patients more access to Galleri test results than life insurers have.

Clarification: An earlier version of this article gave a different price for the Galleri test. Galleri is charging $949 per test. Some online medical practices that offer the test are charging a total of $1,250 to order the test, get it processed and explain the results.

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Pictured: A Grail staffer at work. The company is marketing a cancer test sells for $949. (Image: Galleri)