Medicare contractor to cover Veracyte's genomic lung cancer test

Palmetto's local coverage determination will be a framework for other Medicare contractors to emulate.

A Medicare contractor has finalized its local coverage determination for Veracyte’s genomic lung cancer test, making it the first such test to be covered for Medicare patients.

Veracyte’s Percepta Bronchial Genome Classifier is a genomic test designed to boost the safety and accuracy of lung cancer screening. The U.S. Preventive Services Task Force recommends annual screening using a CT scan for individuals at high risk for lung cancer. But studies have shown that many patients whose scans indicate they need further treatment, such as surgery, end up not having early-stage lung cancer at all.

In 2015, more than 8 million Americans at high risk of lung cancer became eligible for annual screening, the company said. The Percepta genomic test accurately identifies patients with low risk of cancer, so they can avoid an invasive diagnostic surgery. It has been shown in studies to cut down on unnecessary surgeries on suspicious lung nodules seen on CT scans, the company said.

The contractor, Palmetto GBA, will make its policy available next month, according to a statement. And a pair of contractors are also making moves—CGS Administrators issued a final local coverage determination, while Noridian Healthcare Solutions is expected to finalize its draft LCD. All told, these three finalizations will cover nearly two-thirds of the 57 million people who have Medicare.

"Palmetto continues to be a leader in acknowledging the tremendous advances in patient care and healthcare savings that are enabled by access to Veracyte's high-value genomic tests," said CEO Bonnie Anderson, in the statement. "The significant clinical evidence supporting Percepta met the MolDx program's high standards for coverage and, we believe, will also be key to gaining private insurance coverage and driving the test's adoption as we begin to ramp up commercialization."