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LCA Reiterates Support for Full Medicare Coverage of Screening


Washington, DC [May 1, 2014]--Lung Cancer Alliance (LCA) expressed deep disappointment with yesterday’s Medicare Evidence Development & Coverage Advisory Committee’s (MEDCAC) evaluation of low dose CT screening for seniors at risk for lung cancer.

If the Centers for Medicare and Medicaid Services (CMS) decide not to offer full coverage for lung cancer screening based on this non-binding recommendation, it would have the stunning effect of putting a barrier to access to a proven life-saving benefit for the Medicare population.

The majority of lung cancer cases are diagnosed in people over the age of 65.

In testimony before the committee, LCA President & CEO, Laurie Fenton-Ambrose emphasized the magnitude of the impact on our seniors. “For too long a black cloud of despair and indifference has hovered over this community. Yet, now, we have a convergence of solid evidence and best practices that bring tangible hope for survival.”

Based on proven scientific evidence, including the National Lung Screening Trial (NLST), the United States Preventive Services Task Force (USPSTF) “B” recommendation covering current and former smokers between 55 and 80, the availability of consensus driven, gold standard clinical guidance continuously updated by the National Comprehensive Cancer Network (NCCN), and responsible screening already in community-based practice in centers of excellence nationwide guided by the National Framework of Lung Screening Excellence, Fenton-Ambrose urged the panel  to avoid creating a patchwork system that would provide coverage to those at risk up to age 65 who would then be off beyond.  

The Affordable Care Act (ACA) requires that private insurers cover without copay all preventive services that receive a “B” recommendation or higher from the USPSTF.  Many private insurers are already providing such coverage. The ACA does not mandate that Medicare provide the same coverage for its population. 

Fenton-Ambrose continued, “The Affordable Care Act makes lung cancer screening an Essential Health Benefit. If Medicare does not cover screening we will be faced with the ludicrous situation of a break in coverage at age 65 when risk is greatest.”

CMS has issued final recommendations in the past that differ from the MEDCAC advice. CMS will issue its draft recommendation on coverage in November 2014.

In the meantime, LCA will continue to further the expansion of responsible screening throughout the country. LCA and the dedicated professionals carrying out screening for those at high risk will remain focused on bringing this life saving benefit to those who need it most--the people, especially those seniors, behind the numbers.

“Despite our disappointment, said Fenton-Ambrose, we will look forward to continuing our dialogue with CMS on why full coverage for those at high risk within the Medicare population is the right thing to do.”