Medicare Patients Could Gain Access to Critical Diagnostic Test

January 12, 2018

Nearly 1.7 million Americans learned they had cancer in 2017. Most of these patients began traditional treatments like chemotherapy, radiation and surgery. Yet for many, a groundbreaking new immuno-oncology therapy could have been a better alternative.

Cancer patients’ access to accurate and early diagnostic testing defines their course of treatment. To consider all options, however, patients must overcome their first barrier: lack of health plan coverage for diagnostic testing.

For Americans insured by Medicare, there is some good news. The Centers for Medicare and Medicaid Services has proposed a plan to cover next-generation diagnostic tests for beneficiaries with advanced cancer.

If approved as proposed, CMS’ policy would empower Medicare patients and their doctors to make more informed decisions about their treatment options—decisions that could lead to improved outcomes. CMS’ announcement should also set a precedent for other health plans to cover critical diagnostics.

Covering this innovative diagnostic tool for Medicare patients with advanced cancer – recurrent, metastatic and advanced state – is a step forward. Access could be improved for even more patients, however, if CMS would broaden its policy to include patients diagnosed with earlier stages of cancer and patients who require further diagnostics later in their treatment.

It is also important that CMS continues to cover other diagnostics that have gone through a rigorous approval process and are recognized through local coverage decisions. The information provided by advanced diagnostics is important to all cancer patients and their health care providers.

And while diagnostic testing outlines the path forward for cancer patients, it’s only the first step. Health plan coverage must also reform to ensure accessibility of the recommended treatment, even if it means paying for potentially expensive precision medicine, such as personal vaccines.

In addition, patients need to be able to afford their share of the treatment. Many cancer drugs are “specialty tier” medications, meaning patients pay a percentage of the cost, as opposed to a flat co-pay. Requiring cancer patients to cover 20-25 percent or more of the cost of treatment causes some patients deep financial distress.

To learn more about access to precision diagnostics and cancer treatments, read “Improving Cancer Patients’ Access to Precision Medicine” and watch “Access to Immuno-Oncology Therapies.”

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