Word’s out. Medicare has a lot of money to spend on medical services, and every corporation with something to sell wants in. Jonathan Wosen reports for Stat News on the latest lobbying efforts by Grail to have Medicare pay for its blood-based cancer screening test. Grail sees the dollar signs from getting Medicare coverage of the test, while Medicare’s approval could drive up Medicare spending for a test that might offer only limited benefits.
Grail’s cancer screening test allegedly can identify 50 different cancers in people with no symptoms. The test detects bits of DNA. But, how would that help people? How often would people need the test for it to be useful and what would happen after cancer DNA were detected?
If approved by the Food and Drug Administration (FDA), Medicare might cover the Galleri test, which costs $949. The FDA has not yet approved it. In the last quarter, with the hope of imminent FDA approval, Grail spent $1.07 million pushing members of Congress to support Medicare coverage of this test.
Medicare is not required to cover all preventive care services, as these services are not considered “medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” However, the government has chosen to have Medicare cover a growing list of preventive care services, because preventive services could help bring down people’s health care costs down the road and save lives. If Medicare covered the Galleri test, it would be as a preventive care service.
No one yet knows whether multi-cancer screening tests offer benefits to people without cancer symptoms. Sometimes, cancer lives in your body for decades doing no harm. And, sometimes cancer cells grow so quickly that they are not possible to treat effectively. Time will tell the benefits of the Galleri test and its costs.
Here’s more from Just Care:
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