Ensuring Idaho Medicare beneficiaries receive coverage for cancer detection

Under current law, Medicare only covers preventive services Congress has explicitly authorized, or the U.S. Preventive Services Task Force has recommended.

As the Republican ranking member on the Senate Finance Committee that oversees a wide range of federal policy, including social and health care services programs, I reintroduced S. 1873, the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021. This legislation would ensure Medicare beneficiaries in Idaho and across America have coverage for innovative tests that can detect multiple types of cancer before symptoms develop. This bipartisan legislation will help protect both patients and taxpayers by providing Medicare coverage for screening tests to save lives and costs to the health care system. 

More than 300 leading health care organizations across the United States support the Medicare Multi-Cancer Early Detection Screening Coverage Act. These groups include the Idaho Academy of Family Physicians; Idaho Medical Association; Idaho Senior Living Council; Idaho Society of Clinical Oncology; and Idaho Technology Council. In a letter of support, these groups conveyed the problem, “Today, routine screening is reimbursed for only five types of cancer—breast, cervical, colorectal, prostate, and lung cancer (only in high-risk individuals for lung). That leaves the vast majority of cancers without available screening tests and those cases account for nearly three of every four cancer deaths in the United States each year … Currently, Americans most at risk for cancer—Medicare beneficiaries—will face substantial barriers to coverage of multi-cancer early detection tests, even when they are approved by the [U.S. Food and Drug Administration] FDA.”

Without this legislation, it could take several years after FDA approval for Medicare to cover new early detection technologies for cancer. To ensure timely, consistent coverage of screening items and services, the Medicare Multi-Cancer Early Detection Screening Coverage Act would establish a defined benefit category and reduce such delays, returning health care decisions to providers and patients.

“The Idaho Medical Association applauds Sen. Mike Crapo’s leadership on this important legislation. In my practice, early detection and diagnosis is critical to the health and outcomes for patients. By allowing Medicare to cover multi-cancer screenings, patients and physicians will have increased access to the innovative tools necessary to improve outcomes in the fight against cancer.”-Dr. Joseph Williams, Idaho Medical Association President

Congress has acted previously to ensure Medicare coverage for other cancer screenings, including mammography and colorectal screenings. The Medicare Multi-Cancer Early Detection Screening Coverage Act would:

• Create authority for the Centers for Medicare and Medicaid Services (CMS) to cover the latest diagnostic technologies, once approved by the FDA, including blood-based multi-cancer early detection tests and future test methods that draw on samples of urine or hair;

• Maintain CMS authority to use an evidence-based process to determine coverage parameters for these new tests;

• State that new diagnostic technologies will supplement, not replace, existing screenings and will not impact existing coverage and cost-sharing; and

• Direct the Government Accountability Office to issue a report that tracks utilization and makes recommendations to expand usage.

Fellow Senate Finance Committee Member Senator Michael Bennet, D-Colorado, joined me in reintroducing this legislation that is also co-sponsored by Senators Tim Scott, R-South Carolina, Ben Cardin, D-Maryland, Tom Carper, D-Delaware, and John Barrasso, R-Wyoming. 

Medicare should provide patients access to health care innovations as soon as they are available. I look forward to enactment of this important legislation that will help ensure federal health care policy keeps pace with medical advancements so that Idahoans and all Americans have access to live-saving medical care as soon as possible.