Pfizer gets FDA panel's backing in RSV vaccine race
A panel of outside advisers to the U.S. health regulator on Tuesday recommended Pfizer Inc's (PFE.N) respiratory syncytial virus (RSV) vaccine, bringing it closer to becoming one of the first approved RSV shots for older adults in the United States. The Food and Drug Administration's (FDA) advisory committee voted 7-4 in favor of the vaccine, saying data from the company's study...
CMS Instructs some billing arbitration decisions to resume following court ordered pause
Following the issue of a court-ordered pause to out-of-network payment dispute arbitration, the Centers for Medicare & Medicaid Services is now instructing arbitrators to resume determinations for care that occurred prior to Oct. 25, 2022. The notice, published Friday, tells Independent Dispute Resolution (IDR) entities to refer to instructions laid out in CMS' October 2021...
Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap
Based on current COVID-19 trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023. Coverage for COVID-19 testing for Americans will change. Medicare beneficiaries who are enrolled in Part B will continue...
UnitedHealthcare Clamping Down on Expanded Carrier Screening, Genetic Counselors, Testing Firms Say
While some professional organizations and clinicians have moved of late to embrace expanded genetic carrier screening panels, securing payor coverage for these tests remains a challenge. This divide was recently put into sharp relief as a number of genetic counselors have voiced concerns about a perceived uptick in denials for expanded carrier screening (ECS) claims even as in February the...
Excellus BCBS - March 2023 Connection Provider Newlsetter – Policy Updates
(#2.02.30) Genotyping - Cytochrome p450 (CYP450) for Drug Metabolism/New Policy (#2.02.56) Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) (#2.02.51) Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers
Humana to shed employer group commercial business
Humana is exiting the employer group commercial market after a strategic review of its business lines, the insurer announced Thursday. The review found that the business was "no longer positioned to sustainably meet the needs of commercial members over the long term" and was not playing a key role in supporting the company's other long-term strategic focuses, according to the...
UnitedHealthcare Issues New Policy Expanding Coverage of Precision Oncology Diagnostics
UnitedHealthcare has issued a new policy providing coverage for a variety of molecular tests used to personalize the care of cancer patients. The medical policy, effective April 1, addresses multiple cancer types and test technologies, as well as a spectrum of early- to late-stage indications and clinical applications. However, the major changes from a prior policy made effective Jan. 1 center...
National Government Services Expands Coverage for Bio-Techne's ExoDx Prostate Cancer Test
Medicare administrative contractor National Government Services has released an updated local coverage determination expanding coverage of Bio-Techne's ExoDx Prostate Test. Under the updated LCD, which goes into effect March 1, the contractor will cover the EPI test once per year in patients with at least one prior negative biopsy who need a repeat biopsy and are thought to be at...
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