Patients with advanced cancer will soon have access to more personalized treatment plans because Medicare will now cover genetic tests that sequence tumor cell DNA and help healthcare providers determine treatment strategies. As Wired reports, the Centers for Medicare & Medicaid Services (CMS) announced that for Medicare-enrolled patients with recurrent, metastatic, relapsed, refractory or stages III or IV cancer, such FDA-approved tests will be covered by their insurance. And since other insurance companies tend to take their cues from CMS, privately-insured patients will likely get similar coverage soon as well.
Last November, the FDA approved the largest one of these genetic sequencing tests to date -- a product called F1CDx that can detect genetic mutations in 324 genes. With information about the specific mutations in a patient's tumor cell DNA, physicians can then select treatment plans that better fit that individual patient. Or if a relevant treatment option isn't available, physicians can use the information to determine if patients may be suited for certain clinical trials.
CMS will cover any such tests approved by the FDA and newly approved tests will be automatically covered. There are other similar tests used by doctors that haven't yet been approved by the FDA and in those cases, local Medicare Administrative Contractors will determine whether Medicare will cover the cost on a case-by-case basis.