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Genetic Testing Medicare proposed new rule

Northwoodsgirl
Posts: 559
Joined: Oct 2009

WASHINGTON — Patient groups and drug manufacturers say a proposed rule from the Center for Medicare and Medicaid Services would dramatically restrict coverage of genetic tests for patients covered by those programs — a move which may specifically impact patients deciding between various cancer treatments.

The rule, expected to be finalized next week, stipulates that CMS only cover next-generation sequencing (NGS) tests approved by the Food and Drug Administration. That would leave a small subset of existing diagnostic tools — including the FoundationOne, Oncomine Dx, and Illumina — available to Medicare beneficiaries.

Source: STAT News

cmb's picture
cmb
Posts: 396
Joined: Jan 2018

I wonder how long it will take to get tests results after the rule change, given the likelihood of increased volume of tests that will be funneled to fewer providers. Let's hope more providers work to get FDA certified.

Northwoodsgirl
Posts: 559
Joined: Oct 2009

Good point. Decrease competition and decrease coverage by tightening the criteria for coverage. Anyone who is covered by Medicare should learn how to search the Local Coverage Determinations and National Coverage Determinations. Medicare contracts with commercial insurance companies by geographic region to research and then do the administration of these medical coverage determinations . Most people don’ t know anything about them. 

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