Tag Archives: medicare

Medicare Will Now Cover FDA-Approved Genomic Testing for Cancer Treatment

Medicare Will Now Cover FDA-Approved Genomic Testing for Cancer Treatment
Medicare Will Now Cover FDA-Approved Genomic Testing for Cancer Treatment

Genomic testing is an important tool that helps doctors determine whether or not a patient is a candidate for cancer immunotherapy treatment. Last month, the Centers for Medicare and Medicaid (CMS) made the announcement that Medicare will now cover FDA-approved genetic tests to evaluate cancer.

Giving Patients Access to “Innovative Diagnostics”

Discussion on the issue began several months ago when Foundation Medicine received FDA approval for F1CDx, the first broad genomic cancer test of its kind. The current cost for for F1CDx is $5,800.

At the time of the announcement, CMS administrator Seema Verma issued a statement explaining the decision. CMS believes that it will give cancer patients “enhanced access and expanded coverage when it comes to innovative diagnostics.”

Coverage for genomic and molecular cancer tests that are still in development and not yet FDA-approved does not change with the new policy. U.S. regional Medicare administrative contractors will retain discretion in regards to payment for such testing.

Opening the Door to Accurate Evaluation

For the time being, Foundation Medicine will likely see a surge in the number of specimens submitted to them for testing. In the big picture, the CMS decision will encourage researchers to gather the evidence needed for FDA approval of additional tests.

Experts predict that within a few years another half-dozen companies will join Foundation Medicine in offering FDA-approved testing. One scientist called the decision a “major advancement for precision medicine.”

Genomic Testing and Cancer Immunotherapy from Issels®

At Issels®, we use genomic testing in creating individualized cancer immunotherapy programs that address each patient’s unique needs. Contact us today for more information.

Medicare Coverage for Early Detection of Cancer – What to Know

Medicare Coverage for Early Detection of Cancer - What to Know
Medicare Coverage for Early Detection of Cancer – What to Know

Navigating the ins and outs of Medicare coverage can be a challenge. Here’s what you need to know about this program and how it applies to screenings for early detection of cancer.

Do All Providers Accept Medicare?

• Participating doctors “accept assignments,” meaning they consider the amount received from Medicare along with your co-pay and deductible as payment in full, resulting in fewer out-of-pocket expenses.

• Non-participating doctors don’t always accept Medicare, so you have to pay out-of-pocket. Medicare will reimburse you for the portions they normally cover, but you still incur sizable expenses for the difference.

• Opt-out doctors don’t participate in Medicare at all, making you fully responsible for all charges.

Medicare Coverage for Cancer Screening

• Annual mammograms are covered for women aged 40 and older, while clinical breast exams (CBE) are covered every two years for women at average risk for breast cancer and once a year for those at high risk.

• Women at average risk for cervical cancer are covered for a Pap test and pelvis exam every two years, while women at high risk are covered annually.

• Colorectal screening is covered for people 50 and over based on risk factors and date of last test.

• For prostate screening, men over age 50 are covered 100 percent for an annual PSA blood test and 80 percent for a digital rectal exam (DRE).

Lung cancer screening is covered once a year if you are between 55 and 77 and have a qualifying history of smoking.

State-of-the-Art Cancer Treatment at Issels®

Our personalized cancer treatment programs have helped many of our patients achieve long-term remission. Visit our website for more information.