Lawmakers Urge Medicare Coverage for Cancer Test

More than 130 lawmakers are urging the Obama administration to expand coverage for a lung-cancer test under Medicare that could cost the program billons, calling the preventative screening important for vulnerable seniors.

In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer.

The U.S. Preventive Services Task Force last December recommended the test for people ages 55 through 79 who smoked a pack of cigarettes a day for 30 years, or the equivalent. That's about 10 million Americans. The low-dose CT scan will be covered by private insurance as required by the Affordable Care Act with no copays, beginning Jan. 1.

But the new health care law doesn't require Medicare to cover the screenings, which cost $100 to as much as $400. CMS is reviewing the proposal, with a preliminary decision expected by November.

"Americans pay into Medicare throughout their working lives and deserve to have access to potentially life-saving evidence-based screenings that can prevent further health costs down the road," according to the letter sent this month.

The letter was led by Reps. Jim Renacci, R-Ohio; Charles Boustany, R-La.; John Barrow, D-Ga. and Richard Neal, D-Mass. It was signed by 130 other lawmakers.

A CMS spokesman said the agency's decision will be based on whether the test is "reasonable and necessary," without regard to its cost to Medicare. He declined additional comment until the agency responds to lawmakers.

Lung cancer is the world's top cancer killer, with more than 156,000 U.S. patients dying each year, mainly because it's usually found too late for treatment to do much good. In Ohio, about 4,200 die annually from lung cancer. Most deaths involve Medicare-age people, and most are due to smoking.

One major study found that annual CT scans, a type of X-ray, could cut the chances of dying from lung cancer by up to 20 percent in those most at risk - people ages 55 through 79 who smoked a pack of cigarettes a day for 30 years.

A separate study released last month estimated that it would cost Medicare $2 billion a year to offer the lung scans. Every person covered by Medicare would shell out an additional $3 a month, according to lead study author Joshua Roth of the Fred Hutchinson Cancer Research Center in Seattle.

Tom Murphy, 62, of Woodbine, Md., says he believes older people should have access to the lung cancer screening under Medicare. A former heavy smoker and Vietnam War veteran, Murphy agreed to have the annual scans in 2005 under a trial program at his local hospital. Doctors diagnosed him with lung cancer five years later.

"For anybody who smoked previously, this is a very important screening tool," Murphy said. "I believe had they not detected my cancer early, I probably wouldn't be here with my granddaughter today."

Physician groups are somewhat divided.

The American College of Radiology says without Medicare coverage, 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."

But the American Academy of Family Physicians says the evidence is insufficient to recommend for or against the CT screening. It says doctors and patients must weigh the benefits and potential harms, such as radiation from over-testing and false positive results.