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Exact Sciences Lands Major Payer Coverage for Cologuard Test

By Ron Shinkman, Editor, Laboratory Industry Report Exact Sciences, the Wisconsin-based molecular laboratory, has added an impressive list of names to its roster that are providing some form of coverage or support to its colon cancer assay. Anthem, one of the largest health insurers in the United States, has agreed to provide coverage for Exact’s Cologuard assay to those enrollees who have an indicator for closer-than-typical colon screenings due to potential health issues. Anthem said it would pay for the test for those group of enrollees every three years. According to a coverage statement issued by the company, it considers the use of Cologuard outside of that test group to be investigational in nature and not medically necessary. Exact also announced earlier this month that Aetna plans to cover its Cologuard test and make it available to 967,000 members without an additional co-payment. The three-year agreement between the two companies goes into effect on April 1. “We look forward to working with Aetna to provide their members with a new option for colon cancer screening. Colon cancer is most treatable when caught early, underscoring the importance of routine screening,” said Exact Sciences Chief Executive Officer Kevin Conroy in a statement. […]

By Ron Shinkman, Editor, Laboratory Industry Report

Exact Sciences, the Wisconsin-based molecular laboratory, has added an impressive list of names to its roster that are providing some form of coverage or support to its colon cancer assay.

Anthem, one of the largest health insurers in the United States, has agreed to provide coverage for Exact’s Cologuard assay to those enrollees who have an indicator for closer-than-typical colon screenings due to potential health issues. Anthem said it would pay for the test for those group of enrollees every three years. According to a coverage statement issued by the company, it considers the use of Cologuard outside of that test group to be investigational in nature and not medically necessary.

Exact also announced earlier this month that Aetna plans to cover its Cologuard test and make it available to 967,000 members without an additional co-payment. The three-year agreement between the two companies goes into effect on April 1.

“We look forward to working with Aetna to provide their members with a new option for colon cancer screening. Colon cancer is most treatable when caught early, underscoring the importance of routine screening,” said Exact Sciences Chief Executive Officer Kevin Conroy in a statement.

The Cologuard assay is aimed at adults over the age of 50—the group recommended to undergo regular colon screenings. The test analyzes DNA and blood biomarkers in stool to detect both cancer and potentially precancerous conditions. The assay is not considered a replacement to a colonoscopy.