Panel Says No to Medicare Coverage for Lung Cancer Screening

Zosia Chustecka

May 01, 2014

After a day's deliberation, an advisory panel voted last night against recommending national Medicare coverage for annual screening for lung cancer with low-dose computed tomography (CT) in high-risk individuals.

The Medicare Evidence & Coverage Advisory Committee (MEDAC), composed mostly of clinicians, was asked to vote on a scale of 1 to 5 on whether they were confident that the benefits of such screening outweigh the harms in the Medicare population (persons older than 65 years). The mean score of the vote was 2, which shows low to intermediate confidence, according to press reports of the meeting.

Evidence considered by the panel included results from the National Lung Screening Trial, which show that CT screening significantly reduces lung cancer deaths (by 20% compared with chest x- rays). The results have been hailed as a great step forward for lung cancer and have led to many medical societies recommending screening, including the National Comprehensive Cancer Network (NCCN) and the American Cancer Society, among others. Last year, the United States Preventive Services Force (USPSTF) issued a grade B recommendation for annual CT screening for lung cancer.

Under the Affordable Care Act (ACA), any procedure that receives a grade B recommendation from the USPSTF has to be covered by private insurers without a copay. However, the ACA does not specify that Medicare has to do so.

But the Medicare population is exactly the population that could benefit from lung cancer screening, which is recommended for indivuduals aged 55 to 80 years who have a history of smoking (30 pack/year) and who are currently smoking or who quit within the last 15 years.

The Centers for Medicare & Medicaid Services (CMS) received and accepted 2 formal requests to initiate national Medicare coverage for lung cancer screening, which was followed by an open comment period. The formal requests came from Peter Bach, MD, director of the Center for Health Policy and Outcomes at the Memorial Sloan-Kettering Cancer Center in New York City, and Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance.

In addition, a collection of more than 40 medical societies, including the Lung Cancer Alliance, the Society of Thoracic Surgeons, and the American College of Radiology (ACR), has petitioned the CMS to provide national Medicare coverage of lung cancer screening.

The latest development, yesterday's decision by the MEDAC panel to vote against recommending Medicare coverage for lung cancer screening, has come as a bit of a surprise and has already been condemned by the ACR, which warns that "lives may be lost" as a result.

However, the MEDAC panel recommendation is not binding.

The CMS is expected to issue a proposed decision on the issue by November 2014, and a final decision in February 2015.

Refusing Medicare coverage for lung cancer screening "penalizes many seniors and may result in lives lost," the ACR warns in a statement.

"Without national Medicare coverage for CT lung cancer screening, seniors face a 2-tier coverage system in which those with private insurance will be covered for these exams and many of their lives saved, while Medicare beneficiaries are left with lesser access to these exams and placed at increased risk of dying from lung cancer," commented Ella Kazerooni, MD, chair of the ACR Lung Cancer Screening Committee.

"We strongly urge CMS to act on the evidence and the USPSTF recommendations and provide full national coverage of CT lung cancer screening for high risk patients," the ACR said in a statement.

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