Rationale for Correct Answer

The correct answer is: If he is an ApoE4 carrier and he shares this information, Mark may be disqualified for long-term care, life, and disability insurance

The ApoE4 gene variant is associated with a higher risk of developing Alzheimer's disease, which can lead to the need for long-term care and disability services. The 2008 U.S. Genetic Information Nondiscrimination Act (GINA) protects against health insurance and employment-based discrimination.

However, federal and state discrimination laws are not comprehensive and do not fully protect patients in all employment settings. There are gaps in GINA’s protection; specifically, life, disability, and long-term care insurance. GINA does not apply to employers with fewer than 15 employees.1,2

Five of 7 payers with policy positions on ApoE testing state they do not cover ApoE, and 2 apply generic pre-authorization criteria. Rationales supporting coverage decisions include reference to guidelines or national standards, inadequate data supporting testing, characterizing testing as investigational, or that testing would not alter patients' clinical management.3 Insurance companies typically do not cover direct-to-consumer genetic testing and consumers are not required to share their results with insurance professionals.4

The REVEAL and SOKRATES II clinical trial results support the premise that disclosing ApoE results to cognitively unimpaired adults does not cause adverse psychological outcomes.5,6

1. Joly Y et al. Annu Rev Genomics Hum Genet. 2020;21:491-507.
2. American Medical Association (AMA). Genetic Discrimination. AMA website. (n.d.). https://www.ama-assn.org/delivering-care/precision-medicine/genetic-discrimination
3. Arias JJ et al. Genet Med. 2021; 23:614-620.
4. National Human Genome Research Institute (NHGRI). (2022). Direct-to-Consumer Genetic Testing FAQ. NHGRI website. Updated March 31, 2022. Accessed May 22, 2023. https://www.genome.gov/For-Health-Professionals/Provider-Genomics-Education-Resources/Healthcare-Provider-Direct-to-Consumer-Genetic-Testing-FAQ.
5. Largent EA et al. J Alzheimers Dis. 2021;84:1015-1028.
6. Christensen KD et al. Ann Intern Med. 2016;164:155-163.