Advocacy

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

Advocacy > Advocacy Accomplishments


Newsflash

9/27/2019
FORCE joined over two dozen orgs in urging CMS to reconsider the 14-day Rule, which has created delays in patients receiving test results.

9/24/2019
Signed onto a letter urging the President to waive out-of-pocket costs for seniors on Medicare who have precancerous polyps removed during a screening colonoscopy.

9/3/2019
We joined over 50 orgs representing patients, advocates, caregivers, researchers, and physicians to express support for appointment of Norman Sharpless as FDA Commissioner.

7/26/2019
FORCE is supporting legislation (H.R. 4078) to reauthorize and increase funding for the Breast Cancer Education and Awareness Requires Learning Young Act (EARLY) Act.

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.

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