OBR OncologyOncologists Wary of Fallout From Proposed Blood Biopsy Coverage Bill

Oncologists Raise Concerns Over Blood Biopsy Insurance Legislation

In light of the reintroduction of the Multi-Cancer Early Detection (MCED) Screening Coverage Act in the Senate, oncologists are voicing apprehensions about the potential complications arising from broader insurance coverage of blood biopsy tests like Galleri. The medical community remains divided on the value of such screenings, which could lead to a complex set of challenges for oncologists if the bill passes.

Key Points:

• The MCED Screening Coverage Act aims to ensure Medicare coverage for blood biopsies screening for multiple cancer types, pending FDA approval.
• Expanded coverage could lead to an increase in screenings, but the results from these tests are often complicated, leading to false positives and negatives.
• Oncologists, particularly those in independent and community practices, are likely to bear the brunt of the diagnostic process, as the tests fall outside of primary care reimbursement.

Additional Points:

• Dr. Vershalee Shukla shared an anecdote of a six-week workup for a patient with a false positive, highlighting the time, cost, and anxiety involved.
• Dr. Daniel Hayes noted that there is no current evidence to suggest that Galleri screening improves outcomes like mortality or metastatic disease.
• A study by the National Cancer Institute is in the works but will take nearly a decade to provide necessary data.

Conclusion:

• The proposed legislation could significantly alter the diagnostic landscape, placing a new set of challenges on oncologists, without clear evidence of improved patient outcomes.

“The one thing I’m opposed to is selling [the biopsies] now and having them reimbursed. Getting them reimbursed legitimizes them.”
– Daniel Hayes, MD, breast cancer specialist at University of Michigan Comprehensive Cancer Center in Ann Arbor

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