Friday, April 20, 2018

New Letter in SCIENCE Comments on CMS NCD for Cancer NGS Testing

  • Phillips et al. publish a letter in SCIENCE about the recent CMS NCD on gene panels in oncology.  
  • Phillips published an op ed on this topic in JAMA a few days ago.


Last November 30, CMS released a proposed NCD requiring coverage with evidence development in a large sector of Medicare cancer patients. 

Concurrently on December 1, Rebecca Eisenberg of University of Michigan Law School and Nobel laureate Harold Varmus of Weill-Cornell Medical School published an article in SCIENCE urging insurance coverage for gene panel tests in oncology patients, but under the umbrella of a coverage with evidence development paradigm.* 

On December 11, OHSU's Vinay Prasad published an article critical of the NCD in Annals of Oncology, here.

The CMS NCD was finalized on March 17 without any coverage with evidence development component.

The public policy commentary on the NCD continues with two new publications this week:
  • Earlier this week, on April 16, JAMA published an op ed on the NCD by Kathryn Phillips of UCSF - here.    
  • Today, April 20, SCIENCE publishes a multi-author article commenting on public policy impliations of the NCD - here.   This letter is by Phillips and ten co-authors (I am a co-author).   
    • Will private payers follow the CMS coverage policy?
    • Coverage for Medicaid patients is uncertain.
    • CMS didn't consider risk-benefit or economic tradeoffs.
    • CMS and other federal agencies need to view this as a beginning of wise oncology policy making, not a conclusion.

* The coincidence of the SCIENCE op ed and the CMS NCD is interesting, if you expect that CMS policies must be secret and not released outside the agency ahead of publication; here.