Exact Sciences is DOOMED!

What major center has a colonoscopy cost of $3k? The most I have seen is $1900 and most insurers and medicare are down below $1200. Also the doctors are telling me the high positive rate they get from Cologuard is not saving any money on the colonocspies because more people are having them. The only money that may be saved if catching the cancer early. We don't have reliable studies on the savings. Our test is designed to drive more colonoscopies and not replace them. Cologuard is hear to stay for 2 more years, maybe 3. Other technology will replace it. I hope that technology is developed by us. $500+ tests are going to be eliminated. We need to get the test charge below $200 for the insurances and medicare to accept this test long range. Liquid biopsies may be the answer but I honestly believe we are at least 7 years away from that. In case all of us have forgotten, health care costs are still going up, not down. We need to prove our test saves money, which we cannot do at this time!

 

Cologuard is one of the most recent innovations in the healthcare industry that has made a big impact on me. Cologuard is an alternative choice to a colonoscopy for consumers that are “50 years or older and at average risk for colon cancer” ("Exact Sciences: Cologuard", 2017). The reason Cologuard has stuck in my mind because I work for a major insurance carrier and although we would offer coverage for this test Exact Sciences was not in-network which would limit the coverage, if any, extended to our members. It was very hard to explain to members why we would cover a routine colonoscopy that is much more expensive and invasive over covering something as simple and easy as the Cologuard. The reason for the lack in coverage is because we base our preventive care coverage on the healthcare reform list, and cologuard is not listed ("Preventive Care Benefits For Adults", n.d.). This can create a lot of abrasion for members because they do not want to get the colonoscopy due to the process of it especially if they have previously had one that was clear. What many consumers may not realize is the true effectiveness of the cologuard. As Lazarus (2014) stated, “Exact Sciences says Cologuard isn't an exact science.” So maybe the service is not as good of an option as we are led to believe, if this test can vary in its reliability should consumers really be risking the chance of colon cancer? That’s one of the reason it took my organization time to cover the test at all, the results have to be proven to be effective.

References:

Exact Sciences: Cologuard(2017). Retrieved from https://www.cologuardtest.com/landing?gclid=EAIaIQobChMIwbGBgZPl2wIVBTZpCh0Wqw1rEAAYASAAEgKbcPD_BwE

Lazarus, D. (2014, August). A good alternative to having a colonoscopy? Maybe not. Los Angeles Times, (), . Retrieved from http://www.latimes.com/business/la-fi-lazarus-20140822-column.html

Preventive care benefits for adults(n.d.). Retrieved from https://www.healthcare.gov/preventive-care-adults/