Dive Brief:
- The Centers for Medicare and Medicaid Services announced on Thursday that Medicare will pay for lung cancer screening using low-dose CT (LDCT) for patients who meet eligibility requirements. The coverage includes a counseling session regarding the risks and benefits of the screening.
- The coverage will apply to Medicare beneficiaries who are between the ages of 55 and 77; who are either current smokers or who only quit within the past 15 years; and who have a history of at least 30 pack years (for example, they averaged one pack per day for 30 years, or two packs per day for 15 years, etc.). They also must have an order from a medical practitioner. About 4 million Medicare beneficiaries are expected to be eligible, according to the nonprofit Lung Cancer Alliance.
- The coverage, which begins immediately, is Medicare's first move to pay for early lung cancer detection.
Dive Insight:
The CMS did not come to the decision easily, because while advocates pushed for the coverage, others criticized the screenings' high rate of false-positives and their cost.
According to Medscape, a 2014 analysis shows that this type of screening program can be expected to detect an estimated 54,900 additional cases of lung cancer over a five-year period, with most of them being caught at an early stage—at a cost increase of $9.3 billion.
The new coverage policy also lays out the precise eligibility and data collection criteria for radiologists and radiology imaging centers.
Whatever the cost, to many, this is considered a win. "This is an important new Medicare preventive benefit, since lung cancer is the third most common cancer and the leading cause of cancer death in the United States," said Patrick Conway, MD, chief medical officer and deputy administrator for innovation and quality at the CMS, in a prepared statement.