Medicare Blog

what are the medicare patient qualifications to cover oncotype dx prostate cancer test

by Mario Runolfsson Published 2 years ago Updated 1 year ago

Does Medicare cover Oncotype DX prostate?

Medicare has established coverage for the Oncotype DX Prostate Cancer test for qualified Medicare patients with early-stage prostate cancer. Exact Sciences believes that every eligible man should have access to the information they need to make confident, informed decisions about their cancer treatments.

Who is eligible for Oncotype DX?

If you have been diagnosed with DCIS (non-invasive) breast cancer (Stage 0) or early-stage invasive breast cancer (Stage I-IIIa), you may be eligible for the Oncotype DX test, a unique genomic breast cancer test that looks at the activity of certain genes in your tumor to provide personalized information not available ...

Is Oncotype DX for prostate cancer accurate?

Specifically, 288 of the 732 genes analyzed, or almost 40%, reliably predicted recurrence; and 198 of 732 (almost 40%) reliably predicted aggressive disease. Based these findings Oncotype DX appears to reliably predict the aggressiveness of prostate cancer at diagnosis.

How do you order Oncotype DX?

STEP 1 - Get specimen kits Request specimen transportation kit boxes by contacting Customer Service at 866-ONCOTYPE (866-662-6897) or email us with your information. Kit orders usually arrive to you within 48 hours.

How much does Oncotype DX cost?

The Oncotype DX test costs about $4,000. For insurance- and payment-related questions, call 1-866-ONCOTYPE (1-866-662-6897) or email [email protected].

When should I get oncotype?

When should I have the Oncotype DX test? You should have the test done when you and your doctor agree that the test results will be helpful for making decisions about chemotherapy treatment.

What is the most accurate test for prostate cancer?

The most accurate test for detecting prostate cancer is a prostate biopsy. This biopsy involves taking a tissue sample from the prostate and examining it under a microscope, which can help your doctor determine whether there is an uncontrolled growth of cells in the prostate gland.

When is Oncotype DX used for prostate cancer?

Oncotype DX Prostate: “Cover post-biopsy for NCCN very-low, low-risk, and favorable intermediate-risk prostate cancer in patients with at least 10 years life expectancy who have not received treatment for prostate cancer and are candidates for active surveillance or definitive therapy.”

What is a good Oncotype score?

A score between 21 and 25 means you have a medium risk of the cancer returning if you get hormone treatment. The benefits of chemotherapy may outweigh the risk of side effects. A score between 26 and 100 means you have a higher risk that the disease might come back.

What genes are tested in Oncotype DX?

Oncotype DX shares the highest amount of genes/proteins with other signatures, 9 genes being common with Prosigna/PAM50 (BIRC5, CCNB1, MYBL2, MMP11, GRB7, ESR1, PGR, BCL, BAG1), 1 gene with EndoPredict (BIRC5), and 4 genes/proteins with IHC4 (ESR1, PGR, HER2, Ki67).

How do you read Oncotype DX score?

The score is a number between 0-100. A low score means the cancer has a lower chance of returning and you have a lower chance of benefiting from chemotherapy. A high score means the cancer has a higher chance of returning and you have a higher chance of benefiting from chemotherapy.

What does the Oncotype DX test measure?

Oncotype DX® is a tumor profiling test. It helps determine the benefit of using chemotherapy in addition to hormone therapy to treat some estrogen receptor-positive (ER-positive) breast cancers.

Is Oncotype DX test covered by insurance?

All major insurance carriers cover the Oncotype DX test for eligible patients with early-stage invasive breast cancer. Medicare has established coverage for the Oncotype DX test for patients with DCIS (non-invasive) breast cancer, although coverage outside of Medicare will vary by insurance plan.

Do you get oncotype with DCIS?

The Oncotype DX DCIS test offers results as a recurrence score. Depending on the recurrence score number, the DCIS has a low, intermediate, or high risk of recurrence. A low risk score is less than 39, and a high risk score is 55 or higher. A score of 39 to 54 is intermediate risk.

Is Oncotype DX FDA approved?

Although not formally approved by the US Food and Drug Administration (FDA), Oncotype DX is currently the only genomic assay recommended in treatment guidelines published by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Center Network (NCCN) and is also recommended by both the ...

What treatment would you recommend if the Oncotype DX test score is 10?

A prospective study shows that women with an Oncotype DX test Recurrence Score between 0 and 10 can safely be treated only with hormonal therapy, allowing them to skip chemotherapy.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 1 2 3 4 5 6 7 8 9