October 15, 2025
Multi-Cancer / Colorectal Coverage & Payments
We remain cautiously optimistic that any eventual longer-term FY26 funding bill will include legislation allowing – but not requiring – Medicare coverage of multi-cancer early detection (MCED) screening [GH, EXAS, GRAL]. Larger firms may nevertheless…
September 11, 2025
[EXAS, GH] Colorectal Cancer Coverage to Get More Crowded
With CMS reopening its coverage policy for colorectal cancer (CRC) screening yesterday after the close, it seems likely that the space will get a bit more crowded for EXAS and GH, as we would expect…
June 27, 2025
[EXAS, GH, GILD, MYGN, HOLX] Preventive Services: SCOTUS Takes
Consistent with our expectations, the Supreme Court today upheld the validity of U.S. Preventive Services Task Force (USPSTF) appointments and – by extension – the mandate that insures cover recommended services without patient cost-sharing, lifting…
April 29, 2025
[EXAS] Screening Uncertainty Post-SCOTUS?
Late last week the U.S. Supreme Court (SCOTUS) ordered the parties in Kennedy v Braidwood – evaluating mandatory cost-free coverage of preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) – to submit…
April 21, 2025
Diagnostics: Supreme Court Quick Takes
Following oral arguments this morning, we continue to believe that the Supreme Court will preserve HHS authority to enforce mandatory cost-free coverage of U.S. Preventive Services Task Force (USPSTF) recommendations, preserving the positive status quo…
April 21, 2025
Diagnostics & Supreme Court Expectations
With the Supreme Court (SCOTUS) to hear oral arguments this morning 10-11 am ET [live stream] on the legality of mandatory cost-free coverage of U.S. Preventive Services Task Force (USPSTF) recommendations, we reiterate our long-held…
March 21, 2025
EXAS, GH: Colorectal Cancer Coverage in Hand, Edits to Come?
An update to CMS’s colorectal cancer (CRC) screening National Coverage Determination (NCD) formally establishes coverage for EXAS’ Cologuard Plus ($592) and GH’s Shield ($1,495), with claims processing likely available within 30 days. While we have…
February 6, 2025
[EXAS, GH, GRAL] Multi-Cancer Coverage: Take 2
Bicameral reintroduction this week of legislation to allow – not require – Medicare coverage of multi-cancer early detection (MCED) tests starting in 2028 bolsters our view of its likely inclusion in a mid-March spending bill…
January 12, 2025
Diagnostics’ New Supreme Court Risk
The Supreme Court’s (SCOTUS) decision on Friday to hear oral arguments in Becerra v. Braidwood, presumably in late March / early April, will likely serve as an overhang for screening test manufacturers [EXAS, GH, MYGN,…
January 8, 2025
Exact Sciences (EXAS): Cologuard Plus Coverage Questions
A Jan. 1 update to CMS’s colorectal cancer (CRC) screening guide appears to support our view that Medicare coverage of EXAS’ Cologuard Plus (0464U: $592) and its 16% rate premium over the legacy version (81528:…