October 31, 2013

Medicare considers coverage of hepatitis C screening



Medicare officials will spend the next several months deciding whether to cover screening for hepatitis C, after other public health agencies recommended one-time screening for baby boomers.

The agency is scheduled to issue a formal proposal for possible screening coverage in March 2014 and make a final decision in June 2014.

In a memo issued Sept. 5, officials at the Centers for Medicare and Medicaid Services (CMS) asked the public for input. Agency officials are specifically interested in clinical studies and other evidence showing that screening leads to an improvement in either short- or long-term outcomes.

Initial public comments from physicians and other health care providers were supportive of coverage. The commenters wrote that they favored screening because the condition is often asymptomatic and because there are effective treatments available.

Earlier this year, the United States Preventive Services Task Force (USPSTF) recommended that physicians offer one-time screening for hepatitis C virus (HCV) to baby boomers born between 1945 and 1965. The task force pointed to recent data showing that about three-fourths of HCV patients in the United States were born between 1945 and 1965.

A risk-based approach alone could miss a substantial number of HCV cases in the birth cohort because of lack of patient disclosure of or knowledge about risks. The one-time screening offers a chance to identify infected patients at the early stage of disease before they develop complications from liver damage, according to the USPSTF.

While age-based screening is less efficient than risk-based screening, the number of Americans who would likely benefit is greater than the number who would potentially benefit from risk-based screening, the USPSTF concluded. The task force gave the evidence associated with the recommendation a Grade B.

The Centers for Disease Control and Prevention has also endorsed universal, one-time screening of baby boomers for HCV. In August 2012, the CDC recommended an age-based approach to screening, citing the limited effectiveness of risk-based screening alone, the rising morbidity and mortality associated with HCV, and advances in treatment (MMWR 2012;61:1-18).

Comments to the national coverage analysis can be made until Oct. 5.


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