Plans make coverage decisions in light of PSA testing guideline

NATIONAL REPORTS-The U.S. Preventive Services Task Force (USPSTF) is no longer recommending the prostate-specific antigen (PSA) screening test for healthy men, but experts say the impact on insurance coverage and treatment decisions remains unclear.

F. Randy Vogenberg, principal at the Institute for Integrated Healthcare, says the decision whether to cover the blood test in a benefit plan will be a risk-verses-reward equation for health insurers. The benefit of early detection could be an incentive for insurers that want to avoid or limit costly procedures downstream.

"From a commercial insurer perspective, they are really into health and wellness and preventive care-this kind of flies in the face of that," he says.

Vogenberg believes health plans will be careful when making coverage policy because they will not want to deter men from getting beneficial prostate screenings. He says the opinions of physicians will play a role in coverage.

Susan Pisano, the vice president of communications for America's Health Insurance Plans (AHIP), says the PSA guidelines are meant to change the physician-patient conversation in the decisionmaking process.

"What we expect to see is when individual clinicians and patients have those discussions-not that everyone will come to the same conclusions-but that when presented with the information about significant risks, that fewer patients will opt to have the test," she says. "And when it's the right thing for the patient, there will be coverage."

She says the emphasis in reaction to the USPSTF guidelines has been focused on the wrong thing.

"The real value is the information being provided to patients to let them make their decisions," she says. "There is likely to be a change in clinical practice because physicians will be giving a different presentation than they gave before."