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Exact Sciences Gets Medicare Reimbursement, Pursues Private Insurers

Xconomy Wisconsin — 

In another important step for Exact Sciences, the Madison, WI-based company said today that the Centers for Medicare & Medicaid Services (CMS) will reimburse the use of its colon cancer diagnostic at $502 per test.

Exact’s (NASDAQ: EXAS) stock closed at $24.90 per share today, up more than 2 percent from yesterday’s close.

CMS had previously announced it would cover the test for Medicare patients, but the reimbursement rate wasn’t confirmed until today. Exact got the reimbursement rate that financial analysts expected. Patients covered under Medicare Part B will pay nothing out of pocket, while Medicare Advantage patients might have to pay a co-pay or co-insurance fee, an Exact spokeswoman said.

Exact must still convince private insurers to cover the test, dubbed Cologuard, which has a list price of $599. Exact has signed up at least one private insurer so far, Group Health Cooperative of South Central Wisconsin. The company intends to negotiate with private insurers to reimburse the test at a higher rate than Medicare, Exact CEO Kevin Conroy told Xconomy.

In a 10,000-patient study, Exact’s stool-based DNA test detected colorectal cancer 92 percent of the time. The cancer is treatable when detected early, but an estimated 23 million Americans between the ages of 50 and 75 aren’t getting screened as recommended by healthcare providers, Exact says. Colorectal cancer is the second-leading cause of cancer-related deaths in the U.S., trailing only lung cancer.

In August, Cologuard received FDA approval the same day it received preliminary Medicare coverage, a first for a healthcare technology.

Over the past few months, Exact has embarked on an aggressive sales and marketing campaign for Cologuard that has yielded some early traction among doctors and healthcare systems—and shot the company’s stock to its all-time high in October.