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Tricare will again cover breast cancer tests

Aug. 3, 2012 - 01:50PM   |   Last Updated: Aug. 3, 2012 - 01:50PM  |  
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Genetic tests for breast cancer gene mutations will again be covered for some Tricare beneficiaries under a new program, the Pentagon announced this week.

Tricare providers will accept patients for the tests, commonly known as BRCA1 and BRCA2, beginning Sept. 30. Coverage will be retroactive to May 22, according to a release from the Tricare Management Activity.

The Oncotype DX Breast Cancer Assay, a test that analyzes tumor tissue at the molecular level, also will be covered under the same demonstration program, according to Tricare.

Before this year, Tricare or the individual services offered the BRCA cancer screenings for high-risk individuals under special programs, research projects and at some military treatment facilities. In January, Tricare stopped covering the tests. A Tricare official said changes made by the American Medical Association to its testing procedure codes led Tricare to place the tests on the government's "no pay" list.

Under federal regulations, the tests are considered "medical devices" that cannot be cost-shared because they do not have approval from the Food and Drug Administration. In order to offer the screenings again, Tricare placed them in a pilot project designed to "determine whether they are safe and effective."

The pricey screenings, which cost up to $2,000, will not be available to all beneficiaries.

The criteria for which tests will be covered and for whom — usually individuals with one or more close relatives who have had breast cancer or those already diagnosed with certain tumors — will be published by Tricare in August.

In April, Sen. Jon Tester, D-Mont., a member of the Senate Cancer Coalition, implored the Defense Department to offer the screenings. He wrote Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson urging Tricare to reconsider its payment procedures.

On Wednesday, Tester called the Pentagon's decision "a victory" for service members, retirees and families.

"This safe test will make a big difference in women's lives, and I will keep fighting to make sure that red tape doesn't prevent our troops and their families from receiving the quality health care they earned," Tester said.

One in eight women nationwide will develop breast cancer.

According to the Clinical Breast Care Project at Walter Reed National Military Medical Center, more than 2,000 cases of breast cancer have been diagnosed in active-duty service members in the past decade.

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