Oncology, Patient Advocacy Groups Petition CMS for Full Coverage of CT Lung Cancer Screening

Posted by Samantha Powell on March 27th, 2014 |

Date: 3/27/14
Outlet Full Name: Hematology Oncology Today
Author: No author

The Lung Cancer Alliance, the Society of Thoracic Surgeons, the American College of Radiology and other medical organizations recently petitioned CMS to provide national Medicare coverage for low-dose CT lung cancer screening for patients at high risk as defined by the United States Preventive Services Task Force.

In December, the United States Preventive Services Task Force (USPSTF) recommended screening of adults aged 55 to 80 years who have a 30 pack-year smoking history and either currently smoke or have quit within the past 15 years.

The petitioning medical and patient groups are seeking full national coverage for high-risk patients as defined in the USPSTF recommendations, and to provide coverage with evidence for other high-risk patients not currently included in USPSTF recommendations using data collected through existing registries.

“Lung cancer kills more people each year than breast, colon and prostate cancers combined. For each of these other three cancers, there are well established screening tests and programs. We strongly urge CMS to implement broad national coverage so that those at high risk, can be screened, providing the opportunity to save thousands of people each year from this terrible disease,” Douglas E. Wood, MD, immediate past president of the Society of Thoracic Surgeons, said in a press release.

The Affordable Care Act (ACA) requires that private insurers cover all medical exams or procedures that receive a grade of “B” or higher from the USPSTF without a co-pay. However, the ACA does not specify that Medicare provide full national coverage for beneficiaries.

“The USPSTF’s recommendation that made lung cancer screening an essential health benefit specifically included 65 to 80 year olds who are also part of the Medicare population,” said Laurie Fenton Ambrose, the Lung Cancer Alliance president and CEO. “If Medicare does not extend full coverage for lung cancer screening to this population, the net effect will be a two-tier system that leaves Medicare beneficiaries at greater risk of dying from lung cancer than those with private insurance. This cannot be right.”

National Lung Cancer Screening Trial results and those of other smaller international randomized controlled trials demonstrated that CT lung cancer screening significantly reduced lung cancer deaths. Screening for current and former smokers with low-dose CT is the only method ever proven to reduce lung cancer mortality in this high-risk population and it also has been shown to be cost-effective.

“CMS should act on the USPSTF recommendation to provide national coverage for high-risk Medicare beneficiaries and support quality screening programs across the country. This would, for the first time, enable healers and patients to strike a major blow against the nation’s leading cancer killer,” said Paul Ellenbogen, MD, FACR, chair of the American College of Radiology Board of Chancellors.

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