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Highmark BCBS to Cover MDxHealth Prostate Cancer Test

NEW YORK (GenomeWeb) – MDxHealth announced today that it has received a positive medical coverage policy decision for its ConfirmMDx for Prostate Cancer test from Highmark BCBS, a company affiliated with Blue Cross Blue Shield.

Highmark is based in Pittsburgh, Pennsylvania, and covers 5.2 million people through insurance plans in Pennsylvania, Delaware, and West Virginia, MDxHealth said. It's the fourth-largest BCBS affiliate, and the second such insurance company to cover Confirm MDx. MDxHealth announced last week that BCBS-affiliated Independence Blue Cross would also cover ConfirmMDx.

"Highmark Blue Cross Blue Shield's positive policy decision adds to the momentum we are seeing in payer adoption of the ConfirmMDx for Prostate Cancer test," said MDxHealth CEO Jan Groen in a statement. "This decision further validates the impact ConfirmMDx has on patient outcomes and reduction in cost to the US healthcare system."

In March, the test was included in the US 2016 National Comprehensive Cancer Network (NCCN) Guidelines for prostate cancer screening. "Tests that improve specificity in the post-biopsy state — including 4Kscore, PHI, percent free PSA, PCA3, and ConfirmMDx — should be considered in patients thought to be higher risk despite a negative prostate biopsy," according to the NCCN guidelines.

ConfirmMDx is an epigenetic tissue-based test for the early detection of prostate cancer, specifically aimed at addressing false-negative biopsy concerns. It has qualified for Medicare, Medicare Advantage, and other private reimbursement plans, MDxHealth said.

The company also received positive coverage decisions for the test from Michigan-based health plan Priority Health in June and from Cigna in August. And earlier this month, ConfirmMDx was included as an in-network benefit under the California Medical Assistance Program.