Exact Sciences believes that everyone should have access to the information they need to make confident, informed decisions about their cancer treatments. That’s why Exact Sciences created the Genomic Access Program (GAP), which helps eligible patients navigate insurance and other payment options for Oncotype DX GPS tests.
Now favorable intermediate-risk prostate cancer patients are covered by Medicare
Your role in insurance coverage
Medicare covers the Oncotype DX Genomic Prostate Score (GPS) test for eligible patients (NCCN very low, low, and favorable intermediate-risk disease). We assist your patients through the claims with their insurance company, including with your permission, help with appeals for any denial of coverage.
If your patient's insurance covers the test, our patient assistance program, Genomic Access Program (GAP) will:
- Work with the physician to get prior authorization from your insurance company (if required).
- Bill insurance companies directly when possible.
- Process the claim once the test is complete.
- 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. Learn more details by contacting Customer Service
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.