Medicare  & Genetic Cancer Testing

Medicare & Genetic Cancer Testing

With Medicare Support, Genetic Cancer Testing Goes Mainstream

This year, nearly 1.7 million Americans will be diagnosed with cancer. Most will find out in the usual way; after having tiny blobs of tissue slurped up through a needle, smeared and stained on a slide, and put under the discerning eye of a pathologist. But starting this week, Medicare patients with advanced cancers will have access to a more 21st century diagnostic: Their cells can now be sequenced, matching patients with the drugs most likely to make a difference.

On Friday, the Centers for Medicare & Medicaid Services announced that the federal healthcare program will cover the costs of cancer gene tests that have been approved by the Food and Drug Administration. Even if you’re not of retirement age, you should think this is a big deal. Private insurers take their marching orders from what Medicare does and doesn’t cover. Which means that genetic testing just became routine care for patients with advanced cancers. And that means precision medicine has finally broken into the mainstream.

“I think the big takeaway is that this type of robust genomic profiling has been viewed as an unmet need,” says Vince Miller, chief medical officer at Foundation Medicine, whose 324-gene panel test was approved by the FDA in November. It detects mutations across all solid tumor types associated with 15 already-approved targeted cancer drugs. It’s not the only test out there covered by the CMS decision, but it is the largest. Other commercial cancer panels include one from Thermo Fisher Scientific for lung cancers and one from Illumina for colorectal cancer. And any tests that gain FDA clearance in the future will automatically receive full coverage.

That means that in the short term, Foundation Medicine will almost surely see a massive boost in the number of formalin-fixed tumor tissues coming into its two laboratories. But it won’t have the monopoly many feared.

Olivier Elemento, director of the Caryl and Israel Englander Institute for Precision Medicine at Cornell, has been critical of the initial policy CMS proposed, which would have excluded genetic tests that are still under development—some of which doctors have been relying on for years. Elemento’s team at Cornell, for example, has developed a whole exome test that compares mutations in tumors against healthy cells across 22,000 genes. To date, it’s been used to help match more than 1,000 patients in New York state with the best available treatment options.


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