CMS Should Maintain Coverage for Genetic Testing for Hereditary Cancers, Organizations Request

February 5, 2019

On January 31, ASCO joined more than 60 organizations in requesting the Centers for Medicare & Medicaid Services (CMS) to reverse its recent decision to limit coverage for Next Generation Sequencing (NGS). The organizations expressed concern that the decision will make it harder for patients to access medically necessary and relevant clinical tests, reducing the quality of their cancer treatment and care.

In a recent decision, CMS determined that Medicare will not cover NGS-based testing for either germline (hereditary) or somatic (non-hereditary) tumors for beneficiaries with early-stage cancer. As a result, only tests that use older, less-advanced, and more expensive non-NGS methods will be eligible for Medicare coverage. This decision will supersede existing Local Coverage Decisions (LCDs) for NGS-based testing for hereditary breast and ovarian cancers and Lynch syndrome.

The organizations urge CMS to revise its decision and maintain coverage for germline (hereditary) tumor testing, and to communicate the change to Medicare Administrative Contractors (MACs).

“CMS should not create additional barriers to Medicare beneficiaries’ access to clinically appropriate NGS-based testing to which other non-Medicare patients have access,” the organizations wrote in their letter to CMS Administrator Seema Verma.

Read the full letter to CMS.

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