- Pacific Edge cancer test not covered by US Medicare payments
- Bladder cancer test accounted for 60 pct company income
- Use of test backed by some medical expert groups
- Pacific Edge resubmitting to Medicare manager for re-inclusion
An attempt for a judicial review of the decision for US Medicare to cease paying for the test was unsuccessful, with the judge last week saying the court had no jurisdiction. Photo: Supplied / Pacific Edge
Dunedin-based cancer diagnostic firm Pacific Edge has been dealt a severe financial blow after its key testing procedure was excluded from coverage by the United States Medicare federal health insurance scheme.
The firm has been battling for more than a year to overturn a draft decision by a regional manager of the Medicare scheme to cease paying for the bladder cancer tests.
However, the new coverage regime has now come into force and excluded Pacific Edge's test, which accounted for 60 percent of the company's income.
"We are obviously disappointed we have been unable to maintain coverage of our tests in the short term," chief executive Peter Meintjes said.
"This finalisation is a poor outcome for Medicare patients and urologists, as it removes coverage for guideline-recommended testing and followed a flawed process that failed to review the most-current evidence."
An attempt for a judicial review of the decision was unsuccessful, with the judge last week saying the court had no jurisdiction, and lobbying of new political appointees to various health authorities had come to nothing.
The company's tests are still being used and paid for by private health insurance providers, and the US Veterans Administration.
Meintjes said the company has resubmitted one of its tests for reconsideration, which is likely to take months, but had planned for the possibility of not getting coverage.
"We will update shareholders as these plans are finalised, though our focus will remain on further evidence generation in parallel with the reconsideration pathway made available to all providers seeking Medicare coverage of their tests."
Pacific Edge has already restructured to cut staff and costs to limit its cash burn, and previously said it would also look to diversify markets.
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