The Centers for Medicare and Medicaid Services is now covering Food and Drug Administration approved or cleared laboratory diagnostic tests using Next Generation Sequencing for patients with inherited ovarian or breast cancer.
WHY THIS MATTERS
As a result of the decision, more Medicare patients will have access to Next Generation Sequencing in managing other types of inherited cancers to reduce mortality and improve health outcomes.
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Medicare patients with inherited cancers have few treatment options available and the decision expands access to NGS testing for these patients and gives them more opportunities to personalize their cancer care.
Using genetic tests gives patients a more complete profile of their cancer cells and may help identify proven, targeted treatments. Patients who use NGS tests may also find they are good candidates for cancer clinical trials.
The agency is also now providing Medicare's Administrative Contractors with discretion over whether to cover certain other indications.
THE LARGER TREND
Over the last several years, CMS has been actively monitoring the rapid innovation of NGS tests and the evolution of cancer diagnostic tools.
NGS tests provide the most comprehensive genetic analysis of a patient's cancer because they enable simultaneous detection of multiple types of genetic alterations.
Medicare first began covering laboratory diagnostic tests using NGS in March 2018 for Medicare patients with advanced cancer that met specific criteria.
ON THE RECORD
"Innovative technologies are transforming medicine, and at every turn, President Trump has shown a dogged determination to give Americans access to them," said CMS Administrator Seema Verma "We recognize that cancer patients shoulder a heavy burden, so we're leaving no stone unturned in supporting women's health and getting all patients the care they need. NGS testing provides clinically valuable information to guide patients and physicians in developing a personalized treatment plan."
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