The Health Policy War Room

The 2025 NCCN Guidelines for Patients highlight the critical role of genetic testing in managing hereditary cancers like breast, ovarian, pancreatic, and prostate cancers. The guidelines emphasize early identification of pathogenic gene variants to enable personalized screening, preventive surgeries, or targeted treatments like PARP inhibitors. They advocate for pre-test counseling, multi-gene panel testing, and tailored follow-up care based on patient history and familial risk. For payers, this shift encourages reconsideration of restrictive policies that exclude testing for asymptomatic individuals, aligning with preventive healthcare goals. Developers of genetic tests can leverage these recommendations to support coverage and reimbursement by demonstrating clinical utility and economic value.

For medical device manufacturers, securing Medicare coverage is a critical milestone, yet navigating the complexities of the coverage determination process has long been a challenge. With the introduction of Medicare’s Transitional Coverage for Emerging Technologies...

As the Medicare Advantage market continues to evolve, thinking strategically and leveraging the expertise of an experienced consultant can make the difference between a product that flounders and one that thrives. By understanding the landscape, aligning with payer priorities, and planning market entry carefully, health technology developers can navigate the challenges brought on by plan reductions and policy shifts. Consultants provide the insight and experience necessary to turn these challenges into opportunities, ensuring that companies not only survive but succeed in the competitive and ever-changing world of Medicare Advantage.