All PlansCoverageMedium impact
Germline Genetic Testing for Pancreatic Cancer Susceptibility Genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, and TP53)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Gastroenterology, Internal Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage criteria for germline genetic testing for pancreatic cancer susceptibility genes. BRCA1, BRCA2, and PALB2 testing is considered medically necessary for treatment selection in pancreatic cancer patients, while testing for other genes (ATM, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PMS2, STK11, TP53) remains investigational unless meeting other policy criteria.
Action Required
Immediately: Review current genetic testing orders for pancreatic cancer patients. Ensure documentation supports medical necessity for BRCA1, BRCA2, and PALB2 testing when used for treatment selection (platinum-based chemotherapy or olaparib). Flag orders for other pancreatic cancer susceptibility genes as potentially investigational unless patient meets criteria under related policies. Update prior authorization workflows to distinguish between medically necessary and investigational genetic tests.