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Doctors Warn: Medicare Could Halt Key Cancer Test
10 Sep
Summary
- Medicare may stop covering certain DCIS biomarker tests.
- Doctors argue tests help tailor breast cancer treatment.
- The decision impacts Medicare's approach to new tech.
Medicare's Molecular Diagnostic Services Program (MolDX) is proposing to end coverage for certain DCIS biomarker tests, sparking concern among physicians. These tests, like DCISionRT, analyze tumor characteristics to aid treatment decisions for ductal carcinoma in situ (DCIS), a common noninvasive breast cancer. Doctors warn that losing access could complicate identifying patients who need radiation therapy, potentially leading to unnecessary treatments or undertreatment.
Palmetto GBA, administering MolDX, reviewed numerous studies and found insufficient evidence that current biomarker tests outperform existing tools in predicting who can forgo radiation. This reevaluation by Medicare comes as the agency determines its approach to other emerging precision-medicine technologies. A final decision is pending, with further advisory panel meetings scheduled for October, potentially shaping future coverage for similar diagnostics.
The potential withdrawal of coverage could create a disparity, leaving older Americans on Medicare without access to tools available to those with private insurance. This situation underscores a larger debate about the evidence required for Medicare reimbursement and the cost-effectiveness of personalized medicine, with implications for numerous diagnostic services across the Medicare system.
