Oncotype DX AR-V7 Nucleus Detect is now covered by Medicare for your mCRPC patients
The Oncotype DX AR-V7 Nucleus Detect test is covered by Medicare for patients with metastatic castration-resistant prostate cancer (mCRPC) who may benefit from continued androgen receptor signaling inhibitor (ARSi) therapy, such as enzalutamide, abiraterone and apalutamide, as well as those who are resistant who may benefit from chemotherapy. Since private insurance coverage can vary across the country, it’s a good idea to check with your patient’s insurance carrier or contact our to confirm coverage. In addition, Exact Sciences created the Genomic Access Program (GAP) to help patients navigate insurance and other payment options for Oncotype DX tests. Customer Service
Exact Sciences believes that everyone should have access to the information they need to make confident, informed decisions about their cancer treatments.
The GAP team can:
- Contact insurance companies on patients’ behalf.
- Work with clinicians to get prior authorization from insurance companies (if required).
- Bill insurance companies directly when possible.
- Process the claim once the test is complete.
- With your consent, assist in the appeal process if a claim is denied.
Exact Sciences offers financial assistance programs for eligible patients with financial hardship. These programs are based on financial eligibility. Contact Customer Service by phone at 866-ONCOTYPE (866-662-6897) or email us for more information.
The Medicare 14-Day Rule
Exact Sciences Corporation (Exact) is committed to compliance with all applicable laws, rules and regulations, including billing regulations promulgated by the Centers for Medicare and Medicaid Services (CMS). When a laboratory test such as Exact’s OncoType DX test is ordered for a hospital inpatient within 14 days of the patient’s discharge from the hospital, CMS regulations require Exact to bill the hospital directly for that test. This rule is commonly referred to as the “14-day rule.” The 14-day rule is part of CMS’ Date of Service Regulation (42 C.F.R. Section 414.510). As of January 1, 2018, the 14-day rule does not apply to tests ordered for hospital outpatients, and Exact bills Medicare directly for such tests, regardless of their order date.
Exact processes test orders as they are received from ordering providers. Clinical judgment should be the determining factor regarding when tests are ordered and Exact does not seek to influence the timing of test orders for any given patient due to billing or other reasons.