Reducing Hereditary Cancer Act of 2025
The Reducing Hereditary Cancer Act of 2025 would expand Medicare coverage under Title XVIII to include germline (inherited) cancer risk management. Specifically, it would require coverage for germline mutation testing for individuals with a personal or family history of a hereditary cancer gene mutation or a history suspicious for hereditary cancer. The testing must follow evidence-based guidelines from nationally recognized oncology organizations (e.g., NCCN, ASCO, SGO), with guidelines that are least restrictive in cases of disagreement among organizations as determined by a Medicare contractor. The bill also requires coverage for risk-reducing surgeries when guidelines indicate they would lower cancer risk, and for evidence-based cancer screenings for individuals found to carry a hereditary cancer gene mutation, with screening frequency not less than annually and aligned with the relevant guidelines. The act takes effect upon enactment for testing, surgeries, and screenings. In short, this bill aims to make genetic testing and subsequent preventive care more accessible to people at high inherited risk of cancer, using established clinical guidelines to determine what is covered and how often testing and screenings can occur.
Key Points
- 1Coverage for germline mutation testing: Medicare would cover genetic testing for inherited cancer-risk mutations in people with a relevant personal or family history, following evidence-based guidelines from recognized oncology organizations.
- 2Definition and governance of testing: The bill defines “germline mutation testing” as testing that adheres to guidelines from organizations such as NCCN, ASCO, SGO, or other MAC-specified organizations, with MACs resolving guideline conflicts by selecting the least restrictive option.
- 3Repeated testing: If germline mutation testing is performed more than once for an eligible individual, Medicare coverage would apply.
- 4Coverage of risk-reducing surgeries: For individuals identified as high risk by the guidelines, Medicare would cover certain preventive surgeries that reduce cancer risk when such surgeries are considered reasonable and necessary.
- 5Increased coverage for evidence-based screenings: Once an individual is found to have a hereditary cancer germline mutation, Medicare would increase coverage frequency for approved screenings (e.g., mammography, breast MRI, colonoscopy, PSA testing) to align with guidelines, with at least annual frequency, and as determined appropriate by the Secretary.