Bill would create Medicare coverage pathway for cancer detection

Photo: John Baggaley/Getty Images

Members of the Senate Finance Committee have reintroduced the Medicare Multi-Cancer Early Detection (MCED) Screening Coverage Act, a bipartisan bill that would establish a Medicare Coverage pathway to new cancer detection technologies, including tests that can detect multiple types of cancer before symptoms appear.

The bill was reintroduced earlier this month by U.S. Senate Finance Committee Chairman Mike Crapo (R-ID) and Finance Committee member Michael Bennet (D-CO), with Ranking Member Ron Wyden (D-OR) and member Tim Scott (R-SC). 

Bipartisan companion legislation (H.R. 842) was also introduced in the U.S. House of Representatives.

WHAT’S THE IMPACT

According to the bill’s sponsors, a Medicare pathway for MCED tests is important because many cancers currently lack an effective screening option.

In addition to creating a Medicare pathway for FDA-approved MCED tests, the bill would authorize the Centers for Medicare and Medicaid Services to provide Medicare coverage for the MCED tests, and maintain CMS authority to use an evidence-based process to determine their coverage parameters.

The bill would also stipulate that new diagnostic technologies will supplement existing screenings, and won’t impact existing coverage and cost-sharing.

Several state and national healthcare organizations have responded positively to the bill, including the American Cancer Society, Association of Cancer Care Centers and Cancer Support Community.

“Cancer screening and early detection are key priorities for the American Cancer Society Cancer Action Network because when cancer is detected at an earlier stage, it is often easier and less costly to treat, and patients are more likely to survive,” said Lisa Lacasse, president of American Cancer Society Cancer Action Network. “We look forward to working with Congress to see this bill passed as soon as possible.”

“MCED tests hold tremendous potential to transform cancer care by enabling earlier detection, but their promise hinges on accessibility,” said Meagan O’Neill, executive director, Association of Cancer Care Centers. “ACCC commends the nearly 400 members of Congress who supported this pivotal legislation last year and is thrilled to see it reintroduced today.”

THE LARGER TREND

Patients are 50% more likely to get breast cancer screenings, and twice as likely to get colorectal cancer screenings, once they’re in the Medicare program, found 2023 Epic Research.

Patients are also more likely to be newly diagnosed with lung cancer, breast cancer, colorectal cancer, prostate cancer, hypertension, hyperlipidemia, coronary heart disease, type 2 diabetes, depression and COPD in the year in which they have their first Medicare encounter.

According to HHS, insurance coverage increases the likelihood of a patient visiting their physician, especially in outpatient, primary care settings; since 2010, the Affordable Care Act has required health insurance companies to cover preventative care, such as cancer and chronic disease screenings.

Yet despite these changes, there have only been modest improvements in screening rates for people in private insurance. That’s relevant for more than just younger patients – most Americans become eligible for government-subsidized Medicare insurance at age 65, but may not join Medicare right at age 65 if they have private insurance, though they could qualify for coverage earlier due to a disability or other factor.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.