WASHINGTON, D.C. – In letters to leadership of the House Armed Services Committee and the Senate Armed Services Committee, the American Clinical Laboratory Association (ACLA) said today that provisions in S. 2014, the Carl Levin National Defense Authorization Act for FY 2015, “provide the necessary clarity to allow TRICARE to restore coverage for molecular pathology testing services, and ensure these and other laboratory developed tests (LDTs) remain available to TRICARE beneficiaries.”
“Clinical labs across the country perform essential lab tests every day that lead to early diagnoses of conditions and arm physicians and patients with critical information necessary to move forward with treatment decisions,” said Alan Mertz, President of the ACLA. “ACLA applauds the Senate for recognizing the importance of molecular diagnostic tests and other LDTs, and urges Congress to include language in the Defense Authorization enacted later this year to ensure all military families, regardless of where they seek health care, can receive the standard of care they deserve.”
In January 2013, without notice to beneficiaries or to health care providers, TRICARE stopped reimbursing clinical laboratories for more than 100 molecular pathology tests – but only when patients use civilian providers – not when care is received in military treatment facilities. Many labs have continued to provide vital testing services to TRICARE beneficiaries, and are still awaiting reimbursement.
ACLA’s letter notes:
“We believe Section 705, Authority for Provisional TRICARE Coverage for Emerging Health Care Products and Services, provides the necessary clarity to allow TRICARE to restore coverage for molecular pathology testing services, and ensure these and other laboratory developed tests (LDTs) remain available to TRICARE beneficiaries.
Laboratory developed tests play a critical role in the diagnosis and treatment of disease. These vital testing services range from routine tests such as pap smears, complete blood counts and tests related to diabetes and cholesterol, to tests to screen for diseases such as Cystic Fibrosis, and tests to determine how to best treat cancers such as leukemia and lung cancer.”
In addition, the letter says:
“While most LDTs continue to be covered in all practice settings, approximately 100 molecular pathology tests are only covered for certain beneficiaries in certain cases. This two-tiered coverage remains in place even when the LDT is recognized as the standard of care and recommended by VA/DoD clinical practice guidelines.”
Mertz concluded, “Molecular diagnostic testing has changed the practice of medicine by directing physicians to the best therapies for their patients the first time, eliminating trial and error, saving the healthcare system untold dollars and in many cases, saving patients’ lives. Lab testing is absolutely key in this exciting process and ACLA supports the Defense Authorization language allowing for TRICARE coverage of these tests to extend to all military families and ensure they have access to leading diagnostic innovations.”
To read the House letter in its entirety, click here.
To read the Senate letter in its entirety, click here.