Medicare may soon cover Prolaris, Decipher tests for prostate cancer

Both Myriad Genetics and Genome DX Biosciences issued media releases today stating that Medicare contractors have issued draft coverage recommendations for tests used to assess the aggressiveness of prostate cancer based on genetic/genomic analyses of tissue from biopsy and post-surgical samples.

According to the media release from Myriad Genetics, the draft local coverage determination for Myriad’s Prolaris test provides for reimbursement coverage for use of this test among the approximately 50 percent of patients diagnosed as having either low- and very low-risk prostate cancer.

By contrast, the media release from Genome DX Biosciences refers to a draft local coverage determination for use of its Decipher test among men who have actually undergone a radical prostatectomy.

Draft local coverage decisions of this type have a built-in a 45-day comment period. After all comments are received and any necessary revisions are made, a final local coverage decision is normally posted within a further 45 calendar days.

The implication of these two draft local coverage decisions is that Medicare may cover the costs of both the Prolaris test and the Decipher test about 3 months from now, here in the USA.

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