New Act Would Mean Wider Medicare Coverage of Genetic Cancer Screening

On Feb. 16, senators from each party introduced a bill called the Reducing Hereditary Cancer Act of 2022 (RHCA) that would require Medicare to cover genomic cancer testing and follow-up screening for individuals with a family history of hereditary cancer.

Current Medicare Coverage of Genetic Cancer Testing

Current Medicare coverage of genetic testing is limited only to individuals that have already been diagnosed with cancer. It doesn’t include proactive cancer screenings or risk-reducing interventions for individuals who have or come from a family with a history of having genetic mutations increasing their risks of cancer.

This diagnosis-based coverage policy is out of step with current science and medical practice, which recognizes the importance of early detection in preventing cancer deaths as well as costly, often unnecessary medical interventions.

The Newly Proposed Legislation

Proposed by a pair of US senators from each side of the aisle (Ben Cardin (D-Md) and Lisa Murkowski (R-Alaska)), the RHCA would fix the coverage gap by amending the current Medicare coverage law, Title XVIII of the Social Security Act, to include germline mutation testing in individuals with a known, hereditary cancer gene mutation in their family or a history otherwise suspicious for hereditary cancer. Specifically, it would mandate Medicare coverage of:

• Genetic testing for germline mutations for individuals with a known, hereditary cancer gene mutation in their family or a history otherwise suspicious for hereditary cancer, subject to a limit of one per individual;
• Risk-reducing surgeries for patients found to have a hereditary cancer mutation, coverage where such procedures are endorsed by evidence-based guidelines; and
• Increased preventive screening frequency where genetic testing determines that an individual has a hereditary cancer gene mutation, increased frequency for evidence-based screenings, at least once a year or at greater frequencies determined in accordance with National Comprehensive Cancer Network (NCCN) guidelines or the Secretary of Health and Human Services.

The provision providing for more frequent preventive screening covers cases where an individual tests positive for a genetic predisposition to cancer but elects not to undergo preventive surgery.

The House of Representatives Bill

The RHCA isn’t the only legislative effort to extend Medicare coverage of preventive genetic testing for high-risk individuals. Last June, a group in the House of Representatives led by Rep. Debbie Wasserman Schultz (D-Fla) introduced a parallel bill, also called the Reducing Hereditary Cancer Act, 2021 (H.R. 4110), to cover hereditary cancer genetic testing for individuals with a history of a hereditary cancer gene mutation in a blood relative or a personal or ancestral history suspicious for hereditary cancer, as well as certain cancer screenings or preventive surgeries to reduce the risk for individuals with a germline mutation associated with a high risk of developing a preventable cancer.

Takeaway

Passage of these bills would certainly be welcome news for not only high-risk individuals and their medical providers but also the manufacturers of genetic screening assays. While both bills have bipartisan support, their prospects of passage remain unclear, at least for now. G2 will continue to track the bills.