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

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:

1. 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.

2. 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."



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.

This is great news for anyone receiving Medicare whether covered because they are over age 65 or younger and disabled.
3 Responses
Avatar universal
Do you also happen to know where to write/e-mail to yell about age limits?  I think this is great news that these tests are going to be routinely covered for ages 45 - 65 and  with very good reason, BUT, people born before 1945 ALSO. have had medical procedures, blood transfusions ( see my hand raised here), etc., and injected drug use has been just as prolific among younger people BEFORE blood screening was available.

I'd like to remind CMS, etc., that it is to THEIR advantage as well as the patient's to catch as many infected hepcs as early as possible.  It is much less expensive to treat this dragon early than it is to treat it late, pay for liver transplants, and all of the anti- rejection meds, or HCC and all the cost there.

Thanks for listening to my rant (not. from the riba : -). ).  Pat
446474 tn?1446351282
CMS has come around to your point of view as far as the cost of treatment vs. advanced liver disease and all of its costs thanks for all the people who have been advocating for years about this issue.

Medicare is for those 65 or older and those that are disabled.

There was a debate for years about making government health care similar to Medicare available to all Americans and the American people decided that is not what they wanted....

As far as testing for others, most people have health insurance that pays for testing yet they don't get tested. For those without insurance there are low cost of free testing available. I believe that there is more of a need of AWARENESS of the issue rather than barriers to testing. Doesn't everyone of us know friends and others who have insurance yet don't get tested? Even us baby boomers who are 3/4 of the people infected still don't get tested. Why?

Avatar universal
Thanks for the update.  I was surprised at how easily and quickly my meds were approved, but that might be because of what you said aboce AND how my doctor's Ofc filed everything.  

I also agree with your question, it should become a routine test on annual,exams, 'wellness' exams , etc.  
think ofmthe money they could save over lifetimes, IF THEY CAUGHT EVERYONE EARLY!

After that, I really want to go out and advocate for others, but have no idea what to do or how to do it.   Pat
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