Response to peer commentaries: prevention for those who can pay

Genetic testing for medically actionable genetic conditions can potentially limit the incidence and societal burden of disease if asymptomatic individuals can convert knowledge of their risk into preventive ormitigating steps.However, the generally treatmentfocusedUS insurance system complicates reimbursement for preventive interventions. In ‘Prevention for those who can pay’, I examined insurance coverage for preventive interventions following genetic testing in asymptomatic individuals.1 Overall, I highlighted the difficulties these individuals may face in obtaining insurance reimbursement, and I problematized the development of policies that increase access to testing for medically actionable genetic conditions without considering insurance reimbursement for the accompanying interventions.Without comprehensive insurance coverage for interventions across all public and private insurances, these developments will only exacerbate entrenched health disparities. In their respective peer commentaries, both Sarah Malanga and colleagues2 and Sonia Sutter3 elaborate on the complexities of insurance coverage in the liminal state between health and disease. I am grateful to the authors for their thoughtful contributions and for the opportunity to continue this critical dialogue. While both commentaries seek to move the conversation forward, they approach it from different angles. Malanga et al. examine publically available insurance policy documents for interventions recommended for individuals with hereditary breast and ovarian cancer (HBOC) and catecholaminergic polymorphic ventricular tachycardia (CPVT) and conclude