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- Make Medicare’s Coverage Process More Transparent: CAP and Advisory Committee Say
The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) voted to recommend updating its Medicare coverage with evidence development (CED) criteria to improve the timeliness of trials and the diversity of data collected. However, the CAP and others, including MEDCAC advisers, remain concerned that CED restrictions will limit patient access. The CAP has been fundamentally involved in ensuring adequate representation for coverage issues facing pathologists in the regulatory landscape.
The MEDCAC advisory panel voted to recommend the agency make its Medicare coverage with evidence development (CED) process more transparent and collect data on more diverse populations.
The CAP also said that the CED process must be selectively used only to provide evidence-based coverage that will accelerate and expand access to patient services and items rather than restrict providers' use. The revised CED criteria did not include patient representatives or drug industry experts.
In November of 2022, the CAP asked the Centers for Medicare & Medicaid Services (CMS) to “improve the current process by using CED selectively to provide evidence-based coverage, establishing specific and transparent timelines, and generally increasing transparency, flexibility, and stakeholder input to incentivize innovation and afford timely access to services for patients.”
The CMS began implementing CED programs in 2005 and has reiterated over the years that the goal is to speed beneficiaries’ access to new treatments and services while additional data are collected. The criteria CED programs must meet were last evaluated and codified in 2014.