The Centers for Medicare & Medicaid Services recently issued a “final national coverage determination,” providing Medicare coverage of Screening for Lung Cancer with LDCT (Low Dose Computed Tomography) effective immediately.
The first ever lung cancer screening coverage is expected to cost roughly $9.3 billion, including the cost of screening, biopsies, and treatments, over the next five years.
Advocates for lung cancer patients welcomed the CMS decision and said in a joint statement with radiology group representatives that the decision will be the first major blow against lung cancer.
Lung cancer is the leading cause of cancer death in the U.S. and more than 80% of lung cancer deaths among men and women are due to smoking. The National Cancer Institute estimated 159,000 deaths from lung cancer in 2014.
The CMS concluded that there is sufficient evidence to support screening coverage for certain beneficiaries. Hence it laid down precise eligibility criteria to cover lung cancer screening with LDCT once per year. To be eligible, beneficiaries shall age 55-77 with a tobacco smoking history of at least one pack per day for 30 years. They could be either current smokers or have quit smoking within the past 15 years. They shall get a written order from a physician or eligible non-physician practitioner.
Some critics believe that the benefits of aggressive screening have been exaggerated. However, the supporters claim that the coverage could help save thousands of lives and help spread better awareness about the disease.
Dr. Patrick Conway, deputy administrator for innovation and quality and chief medical officer for CMS, noted that this could be a significant Medicare preventive measure since lung cancer is the third most common cancer in the U.S. The CMS believes that the decision strikes a balance between providing access to this important screening service and ensuring that the beneficiaries get maximum benefit from the preventive program.