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CMS Coverage of Gene Sequencing Technology for Medicare Cancer Patients

mammogram-1000x800The Centers for Medicare and Medicaid Services (CMS) announced Friday that it will now cover diagnostic laboratory tests using gene sequencing technology for Medicare cancer patients. This means that patients with advanced cancer will soon have access to more personalized treatment plans.

The testing, called Next Generation Sequencing, can help patients and their physicians to make better treatment decisions as well as help more patients to enroll in clinical trials. Patients with recurrent, metastatic, relapsed, refractory or stages 3 or 4 cancers will now be eligible to get the FDA approved tests covered under Medicare.

CMS’s decision to cover such tests comes shortly after the FDA’s recent approval of Foundation Medicines genomic profiling test called FoundationOne CDx. F1CDx can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor. This information will be beneficial in researching what treatment plans are best suited to specific patient needs.

Medicare coverage for tests similar to this type of testing used by doctors that have not yet been approved by the FDA will be determined on a case to case basis.

"We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways," said CMS Administrator Seema Verma in a statement. "That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve."

The good news is that with the ongoing advances in treatments, cancer survival rates continue to climb. Right now there are millions of  cancer survivors and counting in the United States. The quality of life for those living with the disease is improving as well.


If cancer affects your life, you should be able to focus on finding the best treatment and getting better – not on how you'll pay your bills. WATCH this video and find out more options for cancer coverage plans.




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