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United States Senators Ben Cardin (D-MD) and Lisa Murkowski(R-AK) recently introduced the Reducing Hereditary Cancer Act, bipartisan legislation to expand access to medically-appropriate genetic testing to determine an individual’s risk of developing hereditary cancer—and access to evidence-based medical care to reduce risk for those who have a predisposing genetic mutation. The Senate bill is identical to H.R. 4110, introduced in the House in June of 2021.

The new legislation attempts to close an important gap in Medicare reimbursement. Today, Medicare only covers genetic testing for people who have already been diagnosed with cancer, but does not cover cancer screenings or risk-reducing interventions that are considered medically necessary for individuals who have a genetic mutation increasing their cancer risk.

According to a Senate fact-sheet detailing the proposed legislation “Medicare beneficiaries deserve the same standard of care as individuals with private health insurance. This legislation will reduce health disparities while saving lives and money.”

This proposed law intends to bring reimbursement policy in line with guideline-recommended genetic testing for germline genetic mutations that are known to increase cancer risk for two Medicare populations: those with a known hereditary cancer mutation in their family; and those whose personal or family history that suggests a higher risk for hereditary cancer. For Medicare beneficiaries in these categories, the proposed law will provide coverage of increased cancer screening and risk-reducing surgeries.

“This bipartisan bill will improve early detection of hereditary cancers and allow focused, enhanced preventive strategies to reduce unnecessary pain, suffering, and death,” said Robert W. Carlson, MD, CEO of the National Comperhensive Cancer Netowrk (NCCN)—which publishes free, frequently-updated expert-consensus guidelines on genetic/familial risk reduction and other topics. “Medicare beneficiaries deserve access to the same standard of preventive care and early detection as Americans with private insurance. We applaud the sponsors of the ‘Reducing Hereditary Cancer Act’ for taking action to ensure Medicare recipients have equitable access to health care that follows the latest evidence-based guidelines. We are proud to join with FORCE and other leading cancer organizations to advocate for life-saving access to expert-recommended care. Genetic testing for people with familial risk of cancer, followed with appropriate screening and risk-reducing interventions, will save lives and avoid future costly treatments.”

Inherited genetic mutations (BRCA, ATM, CHEK2, PALB2, Lynch syndrome, etc.) are associated with an increased risk for a number of malignancies, including breast, colorectal, prostate, pancreatic, ovarian, stomach, and endometrial cancers. Up to 10% of all cancers are due to a cancer-related genetic mutation; although that number is significantly higher for certain cancers like ovarian, where nearly 25% of cases are due to an inherited mutation. The more prevalent cancer-related genetic mutations are found in approximately one in every 300 Americans, with certain populations and ethnicities having higher rates.

The legislation has garnered supported from dozens of patient advocacy groups, professional societies, cancer centers, and academia including Moffitt Cancer Center, the Huntsman Cancer Institute, the Association for Molecular Pathology, the American Cancer Society Cancer Action Network, and the Genetic Alliance, among others.

A driving force supporting the legislation, along with the NCCN is FORCE (Facing Our Risk of Cancer Empowered).

“With the ability to identify individuals who carry these mutations (via a simple saliva or blood test), there is an opportunity to prevent or detect cancers earlier, when they are easier and less expensive to treat,” explains Lisa Schlager, vice president of public policy for FORCE. “Access to risk-based screening and preventive medicine is critical. We believe this effort aligns with the goals of the Cancer Moonshot and the President’s Cancer Panel report on ‘Closing the Gaps in Cancer Screening.’ This legislation will help minimize barriers to care, ultimately reducing health disparities while saving lives and money.”

Inherited genetic mutations (BRCA, ATM, CHEK2, PALB2, Lynch syndrome, etc.) are associated with an increased risk for a number of malignancies, including breast, colorectal, prostate, pancreatic, ovarian, stomach, and endometrial cancers. Up to 10% of all cancers are due to a cancer-related genetic mutation; although that number is significantly higher for certain cancers like ovarian, where nearly 25% of cases are due to an inherited mutation. The more prevalent cancer-related genetic mutations are found in approximately one in every 300 Americans, with certain populations and ethnicities having higher rates.

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