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Health
Care Financing Administration (HCFA) Requests State Medicaid Plans
to Cover Costs of Genotype and Phenotype Resistance Tests [Letter
from HCFA to Medicaid Directors, January 8, 2001]: The
letter offers assistance to state Medicaid offices for the development
of policies to pay for genotypic and phenotypic resistance tests.
These tests are not FDA-approved, but both tests can be covered
under the "homebrew" status, which does not require FDA
approval. The decision to cover these tests was based in part on
the DHHS guidelines, which recommend resistance testing primarily
for patients who have failed antiretroviral treatment. The recommended
"national limit" on reimbursement, meaning the maximum
to be paid by Medicare, are: genotype - $355.78, phenotypic testing
for 10 drugs - $675.29, and phenotypic testing for each additional
drug up to five - $36.02. Medicaid programs will set their own reimbursement
rates, but will not be allowed to pay more than these Medicare rates.
posted
1/30/2001
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