Coalition urges CMS to reconsider CTC denial

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Image source: TeraRecon

The CTC Working Group, a coalition of physician providers, colon cancer patient advocates and imaging equipment manufacturers, have called for the Centers for Medicare & Medicaid Services' (CMS) to re-open the rule making process for CT colonography (CTC) to consider new clinical data to support colorectal cancer (CRC) screening.

Today less than half of all Americans age 50 and over, those at the highest risk, undergo CRC screening. CMS' decision will reinforce barriers to screening for Medicare beneficiaries, according to the CTC Working Group.

"We were hopeful CMS would allow seniors access to virtual colonoscopies, which can aid in the early detection and prevention of colon cancer and save lives," said Andrew Spiegel, CEO of the Colon Cancer Alliance, a member of the CTC Working Group. "While we believe ample data currently exists to support a positive decision today for Medicare reimbursement of virtual colonoscopy, CMS should immediately re-open the review process to account for any new data and evidence that emerges showing efficacy of CTC in the Medicare population."

Moreover, the CTC Working Group said that since many private insurers reimburse physicians for CTC, CMS' decision to deny seniors access to CTC eliminates patient choice and reinforces different standards of care between Medicare beneficiaries and those with private health insurance.

"By denying seniors access to the same colon cancer screening procedures as those with private insurance, CMS' decision preserves an unequal standard of care between Medicare beneficiaries and those covered by private health insurance," said Ilyse Schuman, managing director, Medical Imaging & Technology Alliance (MITA). "We urge CMS to re-open a coverage decision to consider additional clinical data on the over 65 age population and patient preference. Medicare coverage for CTC will increase colon cancer screenings in the Medicare population, save lives, and reduce Medicare expenditures."

The CTC Working Group expressed their desire to see CMS immediately reopen the rule making process so the agency can continue weighing additional clinical evidence on areas such as the Medicare population and patient preference.