News | September 30, 2014

Call Widens for Medicare CT Lung Cancer Screening Coverage

Patient advocacy and medical organizations lay out infrastructure and quality control measures

September 30, 2014 — More than 60 patient advocacy and medical organizations have joined a coalition headed by the Lung Cancer Alliance, the American College of Radiology (ACR) and the Society of Thoracic Surgeons (STS), in urging Medicare to cover low-dose computed tomography (LDCT) screening for beneficiaries at high risk for lung cancer

In a new joint letter to the Centers for Medicare & Medicaid Services (CMS), the coalition, now including the American Cancer Society (ACS), American Cancer Society Cancer Action Network (ACS CAN) and the American Society of Clinical Oncology (ASCO), outlined conditions under which Medicare should cover the exams; verified quality control measures to ensure safe, equitable care; and asked Medicare to support existing data registries and screening infrastructure. 

“The American Cancer Society carefully considered the evidence supporting screening for lung cancer with low-dose CT scans and issued a guideline recommending screening for people at high risk based on age and smoking history. This vital new screening tool is required by law to be available to most individuals with commercial insurance, but not those covered by Medicare. It’s time to extend coverage to all who may benefit from screening,” said Richard C. Wender, M.D., chief cancer control officer of the ACS. “We look forward to working with other interested parties to encourage Medicare to cover lung cancer screening and ensure that the exams are delivered in a high quality manner.”

“We are pleased the larger cancer community has joined us in calls for Medicare coverage for CT lung cancer screening. This is an important day for seniors and for CMS. An unprecedented coalition of medical, professional and public health leaders has come together to help assure that high-quality CT screening for at-risk seniors can be deployed safely, equitably and cost-effectively,” said Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance.

The United States Preventive Services Task Force (USPSTF) recommended (with a grade of “B”) LDCT lung cancer screening of adults aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The groups want CMS to provide full coverage for this high-risk group, support existing data registry coordination to track outcomes and provide coverage with evidence development for others at risk beyond those in the USPSTF recommendations.

LDCT screening is shown to significantly reduce lung cancer deaths. The test works as well in people age 65 and over as it does in those 50-64. It has been shown to be cost-effective in Medicare and privately insured patients. Published results also show no undue or lasting patient anxiety from the exam results process. 

“The infrastructure is in place to help ensure the quality, safety and consistency of these exams. Medicare just needs to provide coverage to support these efforts and help physicians save lives,” said Douglas E. Wood, M.D., immediate past president of the STS.

The Affordable Care Act (ACA) requires private insurers to cover medical exams that receive a USPSTF grade of “B” or higher. The ACA does not specify that Medicare beneficiaries receive full coverage for these services. As it stands, the privately insured would have ready screening access, while Medicare beneficiaries remain at higher risk of lung cancer death due to lesser screening access.

For more information: www.acr.org, www.sts.org, www.lunccanceralliance.org, www.cancer.org

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