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Advocacy Alert – 9/01/2022

A change to how Medicare covers biomarker tests for cancer may eliminate coverage for bladder cancer patients who want or need these tests.

We need your help to ensure that Medicare continues to cover three screening tests for bladder cancer because early detection saves lives.  Please read the information below and send an email to make your voice heard or copy and paste your comments in an email to: ProposedLCDComments@novitas-solutions.com.

What is this about?

  • A change to how Medicare covers three diagnostic tests for bladder cancer might eliminate coverage for people with bladder cancer who want or need these tests.
  • A company, Novitas, creates policies that will be used to decide if Medicare should cover a test.  Their draft recommendation added three bladder cancer tests (FoundationOne, CXBladder Monitor, and CxBladder Detect) to the list of tests that would not be covered under Medicare.
  • You can help impact this by sending an email during the comment period that closes on September 6, 2022.

How:

Please read the explanations below and send an email to Novitas telling them that all three bladder cancer screening tests should continue to be covered under Medicare. Novitas is currently accepting comments from all stakeholders, including patients and caregivers, as part of their commentary period.  Your talking points should address:

  • Tests such as Cxbladder Detect, Cxbladder Monitor and FoundationOne should continue to be covered and further evaluated
  • Tell your story. Medicare and its providers are here to serve you. If the contractors are not meeting your needs and denying coverage to the newest diagnostics, the cost burden for these diagnostic tests will ultimately fall on patients themselves.

Send your email now

More details:

The Centers for Medicare & Medicaid Services (CMS) currently covers three diagnostic tests for patients that may be at risk of or have advanced cancer. There are three biomarker tests currently available to bladder cancer patients. These tests are being used by clinicians in the diagnosis and treatment of bladder cancer.

The Bladder Cancer Advocacy Network (BCAN) is concerned about a Medicare Administrative Contractor, Novitas, that is advising Medicare about continuing payments for biomarker testing with these three tests. They announced in June 2022 that they would no longer evaluate individual tests. They are going to defer to existing databases that store information about these tests. These databases are useful but not adequate to determine if Medicare should cover a particular test. For example National Cancer Care Network (NCCN) is one source that helps provide data on diagnostic testing to guide these decisions. However, because these were recently approved, there is not enough information documented about these tests for bladder cancer. As a result, Novitas included FoundationOne, Cxbladder Monitor and Cxbladder in the list of tests that would not be covered in the future by Medicare. No explanation has been given on why these tests will no longer be covered for Medicare recipients, even though Novitas is required to review individual tests before coverage is granted or removed.

Questions:

If you have questions about this, please contact Stephanie Chisolm, BCAN’s Director of Education and Advocacy.

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