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Senate Bill Proposes to Expand Medicare Coverage for Hereditary Cancer Testing

NEW YORK – A new bill in front of the US Congress proposes an expansion of Medicare coverage for genomic testing and certain follow-up services in individuals with a family history of hereditary cancer.

Sponsored in the Senate by Senators Ben Cardin (D-Md.) and Lisa Murkowski (R-Alaska), the Reducing Hereditary Cancer Act joins a counterpart initially introduced in the House of Representatives last June by a group led by Rep. Debbie Wasserman Schultz.

"Early detection can be the difference between life and death with a cancer diagnosis," Senator Cardin said in a statement. "Medicare's current restriction on genetic testing for hereditary cancers is out of step with the current science and practice. We have an obligation to ensure individuals with a family risk of cancer have access to key cancer screenings that give individuals a competitive edge in the fight of their lives."

If passed, the bill would amend title XVIII of the Social Security Act such that it mandates Medicare coverage for germline mutation testing in individuals with a known, hereditary cancer gene mutation in their family or a history otherwise suspicious for hereditary cancer. This would be limited to once per individual.

For patients who are found to have a hereditary cancer mutation, coverage would also be guaranteed for risk-reducing surgeries as endorsed by evidence-based guidelines.

For mutation-positive persons who do not to undergo preventive surgery, the bill also mandates reimbursement for preventative screening at an increased frequency – "in compliance with National Comprehensive Cancer Network guidelines or as determined by the Secretary, but no less frequently than on an annual basis."

Senator Murkowski added that her support of the legislation stems from learning about a constituent's own experience seeking hereditary cancer testing. "That person's family was fortunate to have access to the tests, but I want to ensure more Alaskans have the same opportunity. This legislative fix ensures that anyone covered by Medicare has the same access," Murkowski said.