SWHR Expresses Concerns About CMS Guidance for Next Generation Sequencing

Policy Engagement

Published 1/31/19

In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, SWHR expressed concern about CMS’ new guidance to Medicare Administrative Contractors (MACs) on National Coverage Determination (NCD90.2) for Next Generation Sequencing (NGS). SWHR said that CMS’ broad interpretation of the NCD would have a negative impact on women’s health and on investment in women’s health innovations.

NGS technologies have proved crucial to our understanding of altered genetic pathways involved in human cancers. Limiting coverage for these technologies would prevent diagnosis of patients who are at risk for certain genetic predispositions to serious illnesses, including germline breast and ovarian cancer syndromes. SWHR urged CMS to clarify that the NCD guidance is applicable to somatic tumor testing only, and further, to communicate this interpretation to MACs as soon as feasible.

Read SWHR’S Full Comments On The CMS Guidance

SWHR’s letter was cited in this GenomeWeb article, Healthcare Stakeholders Ask CMS Not to Limit Access to NGS Hereditary Cancer Risk Tests.