Bipartisan Bill Aims to Expand Access to Life-Saving Genetic Testing for Medicare Beneficiaries

Strategic Insights -

The Reducing Hereditary Cancer Act, a bipartisan bill re-introduced by U.S. Reps. Debbie Wasserman Schultz (FL-25), Mariannette Miller-Meeks (IA-02), Kim Schrier (WA-08), and Vern Buchanan (FL-13), seeks to expand access to lifesaving genetic testing for Medicare beneficiaries. Currently, Medicare only covers genetic testing for beneficiaries already diagnosed with cancer, regardless of family history or a known genetic predisposition in the family.

The bill aims to remove barriers that block Medicare beneficiaries from accessing heritable cancer screens and medically necessary, guideline-recommended screening and preventative interventions. By expanding access to genetic testing, individuals can learn their risk of developing cancer and take action before it's too late. The legislation has been widely supported by patient advocacy groups, including FORCE and the National Comprehensive Cancer Network, which have praised its potential to save lives and reduce healthcare costs.

Key Takeaways:

  • The Reducing Hereditary Cancer Act would require Medicare coverage of guideline-recommended genetic testing for inherited mutations known to significantly increase cancer risk for two Medicare populations: beneficiaries who have an inherited mutation causing an increased risk of cancer and those with known familial risk of cancer.
  • The bill would enable coverage of appropriate follow-up services, including cancer screening and risk-reducing interventions, for Medicare beneficiaries who undergo genetic testing.
  • Patient advocacy groups, including FORCE and the National Comprehensive Cancer Network, have praised the bill for its potential to save lives and reduce healthcare costs.
  • The legislation aims to provide Medicare beneficiaries with coverage for genetic testing and follow-up care, which is currently not available under Medicare.
  • By reducing the number of advanced-stage cancer diagnoses, the bill could lower healthcare costs and improve outcomes for patients.

Statistics:

  • An estimated 12% of cancers diagnosed in the United States are with a known genetic mutation, which significantly increases the risk of developing cancer (Source: FORCE).
  • Commercial insurance plans and most Medicaid programs cover guideline-recommended genetic testing and follow-up care, but Medicare does not currently provide this coverage (Source: National Comprehensive Cancer Network).
  • The Reducing Hereditary Cancer Act could save the Medicare program an estimated $1.6 billion in healthcare costs over the next decade by reducing the number of advanced-stage cancer diagnoses (Source: Congressional Budget Office).
  • Approximately 1 in 450 Americans have a BRCA2 gene mutation, which significantly increases the risk of developing cancer (Source: National Cancer Institute).
  • Genetic testing can identify individuals at increased risk of developing cancer, allowing them to take proactive steps such as increased cancer screening or risk-reducing surgery (Source: FORCE).

Sources:

  • FORCE: https://www.facingourrisk.org/
  • National Comprehensive Cancer Network: https://www.nccn.org/
  • National Cancer Institute: https://www.cancer.gov/
  • Congressional Budget Office: https://www.cbo.gov/
  • United States House of Representatives: Representative Debbie Wasserman Schultz (FL-25)