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- Cancer Leadership Council Wants Health Plans to Cover Molecular Diagnostic Tests
The Cancer Leadership Council, of which the CAP is a member, asked the Centers for Medicare & Medicaid Services (CMS) to ensure that health plan essential benefits include molecular diagnostic tests and chimeric antigen receptor (CAR) T-cell therapies. The council wants to ensure patients covered by these health plans cover cutting-edge cancer treatment options. The CAP has advocated to ensure patients have access to tests and new therapies.
In the January 31 letter, the Cancer Leadership Council outlined how health plans created under the Affordable Care Act (ACA) should improve their health care benefits offered to their beneficiaries. Specifically, the council noted current essential health care benefits benchmarks lag the scientific advancements for cancer treatments. The group identified two concerns related to cancer treatment advancements: molecular diagnostic tests and CAR T-cell therapies.
In the letter, the group said “[essential health care benefit] benchmark plans may not include coverage of molecular diagnostic tests that are required to fully characterize a patient’s cancer and to support treatment decision-making...Coverage and payment for these tests may not be available due to the limitations of EHB-benchmark plans and the ACA plans that rely on those benchmarks.”