Medicare will begin initial coverage for a genetic prostate cancer test and will consider national coverage. A Medicare administrative contractor, Palmetto GBA, said it will pay for a diagnostic test that evaluates prostate cancer risk in men, and the nation's largest payer will reach out to healthcare stakeholders to see if the test should be covered nationwide.
Prostate cancer is the second-most common cancer in American men. Approximately 28,000 men died from prostate cancer in 2011, according to the Centers for Disease Control and Prevention.
Several stipulations apply to covering Prolaris, a genetic prostate cancer test developed by publicly traded biotechnology company Myriad Genetics. According to a local coverage determination proposed by the CMS, Medicare will only cover Prolaris for prostate cancer patients who are considered low risk or very low risk. Patients also must have a life expectancy of at least 10 years, and the test must be ordered by a certified physician within Myriad's database.