By Robert King | Jan 27, 2020 4:41pm
Medicare can now cover breakthrough laboratory diagnostic tests
that use next-generation sequencing for patients with inherited ovarian or
breast cancer.
The decision, announced Monday by the Centers for Medicare &
Medicaid Services (CMS), is the latest move by the agency to address how to
cover costly new cancer diagnostics and treatments. CMS decided to first cover
lab diagnostic tests using next-gen sequencing in March 2018 for patients with
certain advanced cancers.
“As a result of today’s decision, more Medicare patients will
have access to NGS in managing other types of inherited cancers to reduce
mortality and improve health outcomes,” CMS said in a release Monday.
The agency added that Medicare patients with inherited cancers
have “few treatment options available.” The expansion of testing creates new
opportunities for patients to get more personalized care, CMS added.
“Patients who use [next-gen sequencing] tests may also find they
are good candidates for cancer clinical trials,” the agency said.
CMS added that it is providing Medicare Administrative
Contractors, which are private insurers that process Medicare claims, with
discretion on whether to cover next-gen sequencing tests for other types of
cancers and indications.
The agency has made moves over the past several years to cover
the emergence of pricier cancer treatments and diagnostics.
In August 2019, CMS gave a national coverage determination to
extend Medicare coverage for immunotherapy drugs that comprise CAR T-cell
therapy. The treatments have cost patients up to $1 million after factoring in
hospital administration costs.
Starting in 2020, CMS also increased the new technology add-on
payment from 50% to 65%. CMS can decide to provide an additional payment to a
hospital for new technologies that can significantly improve clinical outcomes.
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