CMS expands coverage to genetic sequencing for cancer patients

CMS will now cover Next Generation Sequencing through FDA-approved or cleared lab diagnostic tests for patients with inherited ovarian or breast cancer.

NGS testing can show multiple types of genetic alterations and is the most comprehensive genetic analysis of cancer. Medicare patients with advanced cancer were covered for NGS since March 2018 under specific criteria. CMS monitored the innovation of NGS testing before expanding it. As the technology continues to evolve, CMS has given Medicare’s Administrative Contractors (MACs) discretion to cover other indications.

“Innovative technologies are transforming medicine, and at every turn, President Trump has shown a dogged determination to give Americans access to them,” CMS Administrator Seema Verma said in a statement. “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.”

NGS testing can help find more ways to personalized care for these cancers, which have few treatment options. The testing can five a more complete profile of cancer cells that can be targeted through personalized treatment and even clinical trials.