44
GI & ENDOSCOPY SECTION
CMS Votes to
Uphold Medicare
Reimbursement for
Cologuard
By Carrie Pallardy
T
he CMS Advisory Panel on Clinical Diagnostic Laboratory
Tests recently held a vote on whether to maintain current
Medicare reimbursement for Exact Sciences' Cologuard.
In July, Exact Sciences' chairman and CEO Kevin Conroy presented a
proposal to crosswalk Cologuard from its current G-code to a CPT code.
e panel's recent meeting was to determine if the colorectal can-
cer screening test would maintain its $492.72 reimbursement aer
crosswalking the code.
e advisory panel unanimously voted to maintain Cologuard's cur-
rent pricing. e vote was 11 to 0, with one abstention.
"CMS will post a preliminary determination aer considering the
July meeting comments, today's panel vote and other written com-
ments. A final determination is expected to be released in the No-
vember timeframe and will be effective Jan. 1, 2016," said Mr. Con-
roy. n
GI Drugs Excluded
From CVS Caremark,
Express Scripts
Coverage in 2016
By Carrie Pallardy
C
VS Caremark and Express Scripts have released lists of medications
that will be excluded from insurance coverage next year, according to
an American Gastroenterological Association report.
CVS Caremark
• Excludes Viekira Pak, prefers Harvoni and doesn't mention Sovaldi: HCV
treatments
• Amitiza: IBS agent
• Relistor: Opioid-induced constipation agent
• Prevacid and Protoni: Proton pump inhibitors
Express Scripts
• Vimozo and Duexis: Anti-inflammatory/anti-ulcer agents
• Asacol HD, Delzicol and Dipentum: Inflammatory bowel agents
• Pancreaze, Pertzye and Ultresa: Pancreatic enzymes
• Harvoni, Olysio and Sovaldi: HCV treatments n
