.png)
Sarah Soto, a board-certified, licensed genetic counselor, began her career as a clinical reproductive genetic counselor. Sarah then transitioned to a number of industry roles, including evaluating preauthorization genetic testing requests for medical necessity at Humana and writing and reviewing Health Technology Assessments—unbiased, evidence-based reviews of genetic tests and their clinical applications – at Hayes.
Most recently, Sarah worked at Myriad Genetics and now at GeneDx, where she focuses on strategy and clinical evidence from the payor perspective for both current and future products. Sarah has lectured at national and international conferences and various genetic counseling training programs on topics related to reproductive genetics or payer coverage and reimbursement.
Insights from
Sarah Soto
New research presented at the Medicaid Health Plans of America Annual Conference found that, among children with developmental delay, intellectual disability, and epilepsy who underwent stepwise genetic testing, prior testing added an average of 19 months and $2,039 in genetic testing costs before exome or genome sequencing (ES/GS).
In a budget impact analysis of 5,821 children covered by Medicaid, a first-tier ES/GS approach was associated with an estimated $294 in savings per patient per year over five years. Some Medicaid plans have already updated their coverage policies in response to evidence and professional society guidance. These findings support continued modernization among the remaining plans that still require prior testing, with the potential to reduce unnecessary testing, shorten time to diagnosis, and improve long-term budget performance.