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| Exact Sciences' Cologuard test--Courtesy of FDA.gov |
Exact Sciences ($EXAS) kicked off 2015 with big plans for reimbursement for its stool-based DNA colon cancer test, and now the company has scored key coverage decisions from two major insurers for its diagnostic tool.
The Madison, WI-based company nabbed coverage from Aetna ($AET) and Anthem ($ANTM) for its Cologuard test, a critical win as Exact looks to chart growth for the tool in the coming year. As of April 1, Aetna's Medicare Advantage plan will cover the noninvasive diagnostic without a copayment or co-insurance, making Cologuard available to 967,000 members.
Anthem will cover the test as a medically necessary procedure once every three years "as a screening technique for individuals in whom colon cancer preventive screening is indicated," the insurer said in a policy statement, broadening Cologuard's reach. Anthem covers more than 68 million people including 37 million lives in its health plans.
The decisions mark a big win for Exact as it looks to increase its market share and expand coverage for the test. In October, the company nabbed coveted Medicare coverage for Cologuard, making the tool the first and only approved stool DNA test to help spot colorectal cancer covered by the Centers for Medicare & Medicaid Services. But in December, Aetna and United Health ($UNH) decided not to cover the tests, dealing a blow to Exact.
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| Exact Sciences CEO Kevin Conroy |
Still, CEO Kevin Conroy is forging ahead with ambitious growth plans. Exact has already contracted with 5 to 10 payers and will focus on large and regional payers to gain favorable coverage decisions in 2015, he said. But gaining additional large payers will "take more time," Conroy noted, and the company "would like to see this move along faster and we have a team internally that is focused on it." Exact plans to add 50 to 60 new sales reps to its team this year, potentially boosting insurer confidence in Cologuard and signing on more physicians to the test.
"We believe our team's efforts will trigger more commercial insurers to cover Cologuard during the course of 2015 and we look forward to making announcements about those physicians," Conroy said in a statement.
- read Exact's release
- here's Anthem's policy statement
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