PFAS Blood Test Costs a Barrier for Many Who Fear High Exposure

Blood tests measuring PFAS can help doctors manage risks for patients who have been significantly exposed to the chemicals—but the tests cost up to $600, and insurance generally doesn’t cover them.

“Patients with high levels of PFAS, have a higher risk of certain diseases,” including increased cholesterol and certain cancers, said Rachel Criswell, a primary care physician with Redington-Fairview General Hospital in Skowhegan, Maine.

Yet some of her patients decline PFAS tests, she said. “They can’t afford them.”

Two states—New Hampshire and Maine—have led US efforts to mandate insurance coverage.

New Hampshire approved legislation in 2020. And as part of a broader effort to help farmers whose businesses have been wrecked by per- and polyfluoroalkyl substances, or PFAS, Maine Sen. Stacy Brenner (D) introduced legislation (LD 132) to require state health insurers to cover PFAS blood tests.

A nationwide insurance mandate isn’t really on the horizon, though it is gaining traction on Capitol Hill among leading proponents of PFAS action such as Sen. Jeanne Shaheen (D-N.H.) and Rep. Chris Pappas (D-N.H.). Mandating coverage of such tests is a “bit heavier of a lift” at the national level, Pappas said, and should ensure tests are affordable for the uninsured.

Officials for Anthem Blue Cross Blue Shield, Tufts Health Freedom Plan, and Harvard Pilgrim Care opposed the New Hampshire bill in 2020, but didn’t respond to interview requests.

Bolstering Litigation?

Having insurance pay for blood tests could increase the number of lawsuits plaintiffs file and the damage claims they make, said John Gardella, a shareholder focused on PFAS policies at CMBG3 Law LLC.

Litigants often include costs of subsequent tests and related medical care in their damage claims, he said.

But expanding PFAS testing won’t necessarily be a game changer for plaintiffs, said Thomas B. Alleman, an attorney and director of Dykema Gossett PLLC’s Insurance Industry Group.

“For a toxic tort suit to be successful, the plaintiffs have to prove both general causation and specific causation,” he said. General causation is when a substance is considered capable of causing an injury or condition, while claims of specific causation must meet a higher bar establishing that a substance caused a specific individual’s injury.

That’s a challenge given how ubiquitous PFAS chemicals are in the environment and humans, and given that the diseases or health impacts from exposures can be caused by other factors, he said.

Not Required

PFAS blood tests generally aren’t covered by insurance partly because they lack a mandatory rating by the United States Preventive Services Task Force, according to the Centers for Medicare & Medicaid Services, which administers federal health care programs.

Medicare and Medicaid can cover the tests if deemed medically necessary, ordered by a physician, and conducted by specific certified laboratories, CMS said.

Andrea Amico, co-founder of the New Hampshire-based Testing for Pease, which fights for residents exposed to high PFAS levels from a city-owned well at a former Air Force base, said ideally “polluters should pay” for such testing.

But a federal mandate that insurers cover the tests would fill gaps in state efforts, such as workers employed by out-of-state companies, she said.

Five physicians and scientists interviewed predicted a national insurance mandate would take years and need to overcome obstacles including doctors’ unfamiliarity with the potential health effects of PFAS and how the tests can inform patients’ care. There’s also a dearth of labs able to conduct the testing.

Early Diagnosis

Advocates say making the blood tests more affordable and widely available is key to better protecting the health of people in their communities.

Many point to Sandy Wynn-Stelt, a Michigan resident whose doctor knew she had been highly exposed to PFAS and had high concentrations of them in her blood. His recommendation that she have thyroid tests due to potential risks identified a tumor early enough to have it successfully removed.

“We need PFAS testing, and someone should be paying for that, not the community,” said Linda Robles, founder of the Environmental Justice Task Force in Tuscon, Ariz. It represents people living near Tucson International Airport, now a Superfund site, and Davis-Monthan Air Force Base, which released PFAS to local waters.

“People here are poor,” said Robles, describing her predominantly Latino community, “and cannot afford those kinds of testing.”

“We deserve to know what’s in our blood.”

Criswell, the family physician in Maine, said she uses guidance the National Academies of Sciences, Engineering, and Medicine released last year to determine when she’ll suggest a patient have his or her PFAS blood levels tested.

Jobs that can expose someone to the chemicals or high contamination of their water are among the situations the guidance urges clinicians to consider.

When a patient’s PFAS blood levels hit thresholds set out in the academies’ guidance, she may order tests that wouldn’t be done annually to determine a patient’s thyroid function or testicular health, Criswell said.

Test Limitations

Brita Lundberg, an infectious disease specialist and chair of the Massachusetts Medical Society’s environmental and occupational health committee, said PFAS exposure raises important health and equity concerns. But she isn’t convinced insurance mandates are appropriate.

Current tests can fail to pick up certain PFAS of concern, meaning a patient’s disease risk might not be recognized, Lundberg said.

The tests don’t measure all of the thousands of PFAS, but they measure those most likely to be in the body, at the highest concentration, and of concern to federal agencies, said Robert A. Middleberg, who oversees quality assurance and regulatory affairs at NMS Labs. NMS conducts tests for Quest Diagnostics and Laboratory Corporation of America.

The number of PFAS that can be measured also continues to grow, according to NMS and Eurofins Scientific, another PFAS testing lab.

Questions about PFAS blood tests will be addressed over time as has happened with other emerging diagnostic tools, Middleberg said. Helping doctors understand the tests is part of that process, he said.

The Massachusetts Medical Society committed last year to a program about the health consequences of PFAS, Lundberg said. Other efforts include the University of Cincinnati’s health providers course on PFAS; one-page guidance for people living in PFAS-impacted communitiesand clinicians and a short summary about PFAS blood tests that universities and other groups have developed; and the University of California, Irvine’s educational programs.

While the outlook for expanding insurance coverage anytime soon appears dim, that shouldn’t mean those suffering from PFAS exposures have to choose between paying out of pocket or remaining in the dark, Amico, the New Hampshire advocate, said.

“It shouldn’t be the communities” that pay.