NEW YORK (GenomeWeb) – Medicare contractor Palmetto GBA has agreed to cover Myriad Genetics' prostate cancer aggressiveness test Prolaris for patients who are at intermediate risk for the disease.
In the local coverage determination, which becomes effective on July 10, Palmetto said it would cover the 46-gene expression test for men with favorable intermediate risk prostate cancer determined by needle biopsy that can be conservatively managed and doesn't require surgery or radiation treatment. The LCD lists a number of criteria that the patient would have to meet for test coverage, such as conforming with National Comprehensive Cancer Network guidelines on intermediate risk.
Myriad estimated that 20 percent of newly diagnosed prostate cancer patients are in the NCCN-defined intermediate risk category. Medicare previously agreed to cover Prolaris for men who are at low- or very low-risk for prostate cancer as defined by NCCN guidelines. Combined with the latest LCD, Myriad estimated that more than 70 percent of Medicare patients with prostate cancer will have coverage for Prolaris.
"It is clinically challenging to determine how best to treat men with favorable intermediate risk prostate cancer," Michael Brawer senior VP of Urology at Myriad Genetic Laboratories said in a statement. "Our goal is to provide physicians with genetic information and help them tailor treatments based on patients’ individual risk profiles."