[DATE]
Patient: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
Insurance Company: [INSURANCE_COMPANY_NAME]
Subscriber Name: [POLICY_HOLDER_NAME]
Policy #: [POLICY_NUMBER]
Dear Claims Specialist,
I am writing this letter on behalf of my patient, [PATIENT_FIRST_NAME]
[PATIENT_LAST_NAME], to request coverage for the OncoGeneDx Pancreatic Cancer panel, a
genetic test offered through GeneDx, a high complexity CLIA certified laboratory located in
Gaithersburg, Maryland.
Personal and Family History:
[PATIENT_FIRST_NAME] is a [PATIENT_AGE] year-old [PATIENT_GENDER] suspected to
have hereditary predisposition to pancreatic cancer. [MR./MS.] [PATIENT_LAST_NAME] was
diagnosed with XX cancer at age XX years. [HIS_HER] family history is remarkable for (discuss
family history). [MR./MS.] [PATIENT_LAST_NAME]’s (personal and/or family) history is
suggestive of a hereditary cancer syndrome associated with an increased risk of pancreatic cancer.
However, the only way to thoroughly assess this patient’s future cancer risks is to perform genetic
testing. The results of this genetic test will have a direct impact on this patient’s treatment
and management.
Test Information and Impact of Results on Medical Management:
As you are aware, multiple genes and cancer syndromes are associated with hereditary pancreatic
cancer. The OncoGeneDx Pancreatic Cancer Panel includes analysis of highly penetrant genes
affecting pancreatic cancer risk. Panel testing utilizes next generation sequencing technology, which
allows for analysis of multiple genes simultaneously. This is far more cost effective and timely than
stepwise genetic testing (for example, ordering testing of one or two genes followed by additional
genetic tests, if negative).
An additional benefit of the OncoGeneDx Pancreatic Cancer panel is the ability to test for multiple
hereditary cancer syndromes at once. Many hereditary pancreatic cancer pedigrees display significant
phenotypic overlap with those of other hereditary cancer syndromes. For example, several cases of
pancreatic cancer and breast cancer may be present in a family with hereditary breast/ovarian cancer
syndrome caused by a mutation in BRCA1 or BRCA2, or in a family with a mutation in PALB2 or
ATM. A hereditary cancer syndrome diagnosis cannot always be established based upon the
pedigree analysis alone. The OncoGeneDx Pancreatic Cancer panel tests for genes associated with
multiple hereditary cancer syndromes that may present similarly, including Lynch syndrome, von
Hippel-Lindau syndrome, Li-Fraumeni syndrome, hereditary breast/ovarian cancer syndrome and
others. While each of these syndromes is associated with a significantly increased risk of pancreatic
and other cancers, each syndrome has gene-specific and site-specific cancer risks for which National
Comprehensive Cancer Network (NCCN) management recommendations differ 1,2. These may
include increased cancer surveillance and options for prophylactic surgeries and chemoprevention.
Thus, it is essential that an accurate diagnosis is established for this patient in order to
determine [HIS_HER] appropriate medical management.
Conclusion:
Knowledge of this patient's genetic information is important for me to more accurately assess
[HIS_HER] cancer risks and will guide my recommendations for [HIS_HER] care. I have chosen to
send the patient’s test to GeneDx because this laboratory has highly sensitive, rapid and costeffective genetic testing for hereditary pancreatic cancer, which will provide helpful medical
treatment planning information for my patient.
Thank you for your review and consideration. I hope you will support this request for genetic
testing coverage for [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]. If you have
questions, or if I can be of further assistance, please do not hesitate to call me at
[PHYSICIAN_PHONE_NUMBER].
Sincerely,
[PHYSICIAN_FIRST_NAME] [PHYSICIAN_LAST_NAME], MD
cc: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/Familial
High-Risk Assessment: Breast and Ovarian. Version 1.2015. www.nccn.org.
2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/Familial
High-Risk Assessment: Colorectal. Version 2.2014. www.nccn.org.