This article is more than 5 years old. Information may no longer be current.
CMS Confirms Medicare Advantage Coverage of Cologuard Without Cost Sharing
Click Here to Manage Email Alerts
CMS has released an updated Evidence of Coverage notice confirming that Medicare Advantage plans must cover Cologuard every 3 years without patient coinsurance, copayments or deductibles, according to a press release from the manufacturer.
Cologuard (Exact Sciences) is a multi-target stool DNA test for noninvasive colorectal cancer screening in average-risk individuals. It was approved by the FDA in August 2014 and is included in the recent USPSTF recommendations on colorectal cancer screening as well as the American Cancer Society’s 2014 colorectal cancer screening guidelines, among others.
CMS included stool DNA-based colorectal cancer screening for the first time in its recently issued 2017 model Evidence of Coverage notice for Medicare Advantage Organizations, according to the press release. In 2016, 17.6 million Americans were enrolled in Medicare Advantage plans, representing 31% of Medicare beneficiaries.
“The CMS update assures patients and physicians that Cologuard is covered by Medicare Advantage plans without any out-of-pocket costs,” Kevin Conroy, chairman and CEO of Exact Sciences, said in the press release. “The update is also significant because it reflects CMS’ recognition that Cologuard is an A-graded preventive service under the recently updated USPSTF colorectal cancer screening recommendations. CMS requires Medicare Advantage plans to cover A-graded services without patient cost-sharing.”
Disclosures: Conroy is employed by Exact Sciences.