Medicare now covers screening for Hepatitis B Virus (HBV) infection, effective for services on or after Sept. 28, 2016. Practices should be aware that Medicare coinsurance and the Part B deductible are waived for this preventive service.
Medicare will cover screening for HBV infection, when ordered by the beneficiary’s primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider for these services, within the context of a primary care setting if the screening is:
Performed with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests.
Used consistent with FDA-approved labeling.
In compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
The Centers for Medicare and Medicaid (CMS) will be speaking to states in the coming months about their restrictions on curative hepatitis C treatments for Medicaid beneficiaries, the agency’s Division of Pharmacy Director John Coster said on Tuesday.
Coster made his comments at a briefing in Washington, D.C. sponsored by The Aids Institute titled “An Update on Hepatitis C in the United States.”
CMS issued guidelines last November advising states to use reasonable “management tools” in prescribing expensive hepatitis C drugs such as Harvoni, which boasts a 90-percent cure rate.
Federal officials have long fretted about the mounting cost of prescription drugs for Medicare and other government agencies – especially the newer pricey miracle drugs for the treatment of the Hepatitis-C virus, the potentially deadly liver disease that affects millions of Americans.
A recent annual report of the Medicare Board of Trustees documenting the alarming trends in spending on prescription drugs more than validates their concerns.
Prescription drugs accounted for $97 billion in Medicare spending on seniors in 2014, or nearly 16 percent of all Medicare expenditures that year. Spending on Hepatitis-C virus more than doubled in just five months from just $421 million in November 2014 – shortly after the first of the new drugs had entered the market – to $864 million in March 2015. Spending on the drugs tapered off to $793 million in mid-2015. But officials are bracing for another surge in spending as more and more patients seek the benefits of the new drugs.