The Medicare Evidence Development & Coverage Advisory Committee's low confidence vote last week on low-dose CT (LDCT) lung cancer screening has added some confusion to this health policy issue.
While MEDCAC's decision not to support full Medicare coverage for LDCT screening for at-risk individuals is not binding, it certainly increases the likelihood that the Centers for Medicare & Medicaid Services will follow the committee's findings and decline to provide Medicare coverage.
The Affordable Care Act requires that private insurers cover, without copay, all preventive services that receive a "B" recommendation from the United States Preventive Services Task Force--which LDCT lung cancer screening has received. As organizations like the American College of Radiology and the Lung Cancer Alliance are arguing, if CMS follows MEDCAC's lead, such a course will result in a "patchwork" system that would provide coverage for the screening test up until the age of 65, but then remove it.
"Without national Medicare coverage for CT lung cancer screening, seniors face a two-tier coverage system in which those with private insurance will be covered for these exams and many of their lives saved, while Medicare beneficiaries are left with lesser access to these exams and placed at increased risk of dying from lung cancer," said Ella Kazerooni, chair of the ACR's lung cancer screening committee in a statement following the MEDCAC vote.
While the panel's median vote on the questions concerning LDCT lung cancer screening came in around the "low-confidence" range, there were members who gave LDCT lung cancer screening intermediate confidence votes, which could be significant when CMS decides whether or not to follow MEDCAC's recommendation. In addition, considering the number of groups that expressed their support for LDCT lung cancer screening at last week's meeting, it can be expected that there will be considerable pressure on CMS to come to a different conclusion when it issues its coverage decision.
Considering the evidence, it's possible that could happen. While many of the panel members explained that they were casting their votes based on the fact they weren't convinced that there was adequate evidence that the benefits of LDCT lung cancer screening outweighed the harms, no one refuted that those benefits included an absolute reduction in lung cancer mortality; no small thing when one considers that lung cancer is the No. 1 cancer killer in the U.S.