www.hivandhepatitis.com

Medicare Will Cover Hepatitis C Screening for Baby Boomers and People at Risk

The Centers for Medicare and Medicaid Services (CMS) announced this week that Medicare will cover hepatitis C virus (HCV) screening for adults born between 1945 and 1965, as well as others considered at risk, when requested by a primary care physician or other providers within a primary care setting.

The largest burden of hepatitis C in the U.S. is seen among "Baby Boomers," or middle-aged adults aged 49 to 69 years. The CDC and U.S. Preventive Services Task Force (USPSTF) recommend that all adults born between 1945 and 1965 should be screened for HCV at least once as part of their routine health care.

Many people in this age group may have experimented with injected drugs decades ago or undergone medical procedures or blood transfusions before HCV was identified and blood was routinely tested. Over years or decades chronic HCV infection can lead to serious liver disease including cirrhosis and liver cancer. People infected many years ago are only now reaching the stage of advanced disease.

According to the new CMS National Coverage Determination:

• Screening tests will be covered for adults at high risk for hepatitis C virus infection, defined as people with a current or past history of illicit injection drug use and people with a history of receiving a blood transfusion prior to 1992; repeat screening will be covered annually only for those with continued injection-related risk since their prior negative test.
• A single screening test will be covered for adults who do not meet the high-risk criteria as defined above, but who were born between 1945 and 1965.

"[T]he evidence is adequate to conclude that screening for hepatitis C virus (HCV), consistent with the grade B recommendations by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under [Medicare] Part A or enrolled under Part B," according to the CMS Decision Memo.

"This significant development will aid in nationwide efforts to improve hepatitis diagnosis, care, and treatment detailed in the updated Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (2014-2016)," said Deputy Assistant Secretary for Health Ronald Valdiserri, quoted on blog.AIDS.gov. "We encourage all stakeholders to join in raising awareness about the CMSdecision among both healthcare providers and Medicare beneficiaries who may benefit from an HCV screening, particularly those born between 1945 and 1965 who comprise more than 75 percent of people with hepatitis C in the United States."

6/4/14

Sources

Centers for Medicare and Medicaid Services. Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults (CAG-00436N). June 2, 2014.

AIDS.gov. Medicare Will Cover Hepatitis C Screening in Primary Care Settings. Blog.AIDS.gov. June 3, 2014.