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Centers for Medicare and Medicaid Services Covering Screening!

Lung Cancer Alliance Says Centers for Medicare and Medicaid Services “Got it Right”

Favorable Coverage Decision for Lung Cancer Screening Affects 4M

Washington, D.C. [Monday, November 10, 2014] Today, Lung Cancer Alliance (LCA) commended the Centers for Medicare & Medicaid Services (CMS) who “got it right,” said Laurie Fenton Ambrose, LCA President & CEO, by issuing a draft decision requiring Medicare coverage of low-dose computed tomography (CT) lung cancer screening for at-risk beneficiaries.

Approximately four million Medicare beneficiaries fit the eligibility criteria for screening. The decision is aligned with the recommendations submitted to CMS in September by a coalition led by LCA, the American College of Radiology (ACR) and The Society of Thoracic Surgeons that included nearly 100 other professional societies, public health organizations, medical centers and patient groups.  

“Tens of thousands of lives will be saved by providing America’s seniors with fair and equitable access to the same lifesaving lung cancer screening that is now being offered to those with private insurance,” Fenton Ambrose continued. "Now, we will focus our attention on making sure those who would benefit most from this screening actually get screened.”  

LCA has been advocating for early detection for lung cancer since the organization’s inception in 1995. More than a year ago, in October 2013, LCA submitted a request for a National Coverage Determination to CMS. Not long after that, the United States Preventive Services Task Force (USPSTF) issued its final recommendation for annual lung cancer screening of current and former heavy smokers between ages 55-80, making lung cancer screening an Essential Health Benefit under the Affordable Care Act. This requires private insurers to cover screening in 2015.  Medicare was not bound by the USPSTF recommendation.

“By issuing this decision, CMS has avoided creating a perplexing two tiered system of coverage  where lung cancer screening is an essential health benefit for some but not for those at even higher risk for lung cancer – our nation’s seniors,” added Fenton Ambrose. 

The CMS draft decision is the last major piece in a long series of validations reaffirming the lifesaving benefits of lung cancer screening. Lung cancer screening was scientifically proven in 2010 by of one of the largest randomized controlled trials in the history of the National Cancer Institute (NCI).  NCI’s National Lung Screening Trial (NLST) confirmed that screening can reduce overall death from lung cancer – which is currently the number one cancer killer in the U.S. – by at least 20 percent.