Advocacy

FORCE advocates for families facing hereditary breast and ovarian cancer in areas such as access to care, research funding, insurance, and privacy.

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Newsflash

1/31/2019
FORCE spearheaded a stakeholder letter to HHS and CMS expressing concern about interpretation of a national policy which places significant limits on hereditary cancer genetic testing in the Medicare population.

1/17/2019
FORCE joined 50 other orgs in an advertising campaign to stop the proposed changes to Medicare Part D’s Six Protected Classes.

1/16/2019
We submitted comments on the Healthy People 2030 initiative asking that genomics goals are incorporated into the plan.

12/31/2018
As a Friends of the Cancer Policy Institute member, FORCE provided comments on the International Pricing Index (IPI) Model for Medicare Part B Drugs.

12/20/2018
Success! The EEOC removed the GINA regulations section allowing incentives/penalties to provide personal health information as part of an employer-sponsored wellness program.

 

Medicare Regions Expand Coverage of Genetic Services

Insurance Coverage & Barriers

Medicare operates on a regional system in which Medicare Area Contractors (MACs) manage the provision of health services for a specific jurisdiction. In the spring of 2015, four MACs--Palmetto, Noridian (Area JF), Noridian (Area JE), and CGS--proposed Local Coverage Determinations (LCDs) that expand and better align their services with National Comprehensive Cancer Network (NCCN) guidelines in a number of important areas, including:

  • Expanding coverage of genetic testing for individuals who have or had cancer consistent with hereditary cancer syndromes, including men and those who are affected by prostate and pancreatic cancer,
  • Coverage of multigene testing panels if more than one mutation may be indicated, and
  • Clarification of the BRCA testing policy for use of the targeted therapy, Lynparza (olaparib).

The draft LCDs were identical so FORCE submitted indistinguishable comments to each of the MACs. Read FORCE's comments submitted to Palmetto in July 2015. The majority of changes were accepted and made final. The LCDs apply to services performed on or after October 5, 2015.

It is important to note that these policy changes apply only to states covered by these MACs:
Arkansas, Arizona, California, Hawaii, Idaho, Kentucky, Montana, Nevada, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Utah, Virginia, Washington, West Virginia and Wyoming

FORCE is encouraging other Medicare Area Contractors to follow suit, bringing all Medicare recipients improved access to genetic services. Two key Medicare coverage issues remain unaddressed:

  • Coverage of genetic counseling and testing for unaffected carriers/previvors. The Centers for Medicaid & Medicare Services (CMS) maintains that its mandate does not permit coverage of genetic testing for individuals who have not had cancer.
  • Medicare recognition of genetic counselors as providers. While medical doctors such as oncologists and geneticists are approved Medicare providers, CMS indicated that recognition of genetic counselors as providers would require statutory change.

FORCE continues to advocate for these issues to be addressed and will provide updates as they become available.

FORCE:Facing Our Risk of Cancer Empowered