NEW YORK (GenomeWeb) – United Healthcare has included coverage of fecal DNA testing for colorectal cancer in its latest Coverage Determination Guideline, making it the final big US insurer to cover Exact Sciences’ Cologuard, according to analysts who cover the firm.
The decision marks a reversal for United Healthcare, which had recently declined to cover Cologuard, citing insufficient evidence to show that fecal DNA tests accurately screen for colorectal cancer in asymptomatic, average-risk patients.
Effective July 1, United Healthcare will cover fecal DNA testing for patients 50 to 75 years old once every three years. The insurer became the latest to cover Cologuard. In late March, Aetna issued updated its colorectal cancer screening policy to note that it now considers Exact Sciences’ Cologuard screening test a “medically necessary preventive service” every three years for average-risk patients 50 and older. Aetna also considers colorectal cancer screening medically necessary for African Americans starting at 45.
Among the other major payors to have previously included Cologuard in their coverage guidelines are Cigna, Humana, and Tricare.
According to Cowen analyst Doug Schenkel, with the United Healthcare coverage, Exact Sciences should have around 95 percent of lives covered heading into 2018.
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