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Payers' Views On Insurance Coverage For Confirmatory Diagnostics After A Noncovered Multicancer Early Detection (mced) Test.

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Payers' Views On Insurance Coverage For Confirmatory Diagnostics After A Noncovered Multicancer Early Detection (mced) Test.

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Payers' Views on Insurance Coverage for Confirmatory Diagnostics After a Noncovered Multicancer Early Detection

Julia R Trosman^1,2,3, Christine B Weldon^1,3, Allison W Kurian⁴

¹1UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS), San Francisco, CA.

Journal of the National Comprehensive Cancer Network : JNCCN

|June 18, 2026

View abstract on PubMed

Summary

This summary is machine-generated.

Most US private payers would cover confirmatory diagnostics after a positive multicancer early detection (MCED) test, but often with restrictions. Developing clear coverage policies and addressing patient cost-sharing are crucial for MCED adoption.

Keywords:

Insurance coverage MCED confirmatory testing multicancer early detection reimbursement

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Area of Science:

Health Economics
Oncology
Health Policy

Background:

Multicancer early detection (MCED) tests are emerging in clinical practice but lack widespread payer coverage.
Understanding payer coverage for necessary confirmatory diagnostics after a positive MCED test is critical for oncology professionals.
This study examines US private payer perspectives on coverage for confirmatory testing following non-covered MCED tests.

Purpose of the Study:

To assess US private payer views on coverage for confirmatory diagnostics after a positive, non-covered MCED test.
To identify potential barriers and payer strategies related to confirmatory testing coverage.
To inform oncology professionals and policymakers about payer perspectives on MCED follow-up care.

Main Methods:

Conducted semistructured interviews with 16 US private payers (national and regional insurers, coverage decision support organizations).
Employed thematic analysis, supplemented by frequency counts, to analyze payer responses.
Focused on coverage policies and perspectives regarding confirmatory diagnostics post-MCED testing.

Main Results:

While no payers covered MCED tests, 63% would cover confirmatory testing, often with clinical restrictions (70%).
Few payers (19%) would cover repeat testing if cancer wasn't diagnosed; none had formal post-MCED policies.
Most payers acknowledged patient barriers but few planned to reduce cost-sharing for confirmatory tests.

Conclusions:

Explicit coverage policies for confirmatory diagnostics are needed, extending beyond MCED to similar novel tests.
Oncology professionals need to be aware of payer coverage nuances for positive MCED results.
Addressing patient cost-sharing is a national policy issue essential for growing MCED adoption.