Cancer diagnostics company, Pacific Edge, has announced that the draft 'Gapfill' prices for its Cxbladder Triage Plus test have been published by the US Centers for Medicare & Medicaid Services (CMS).
The proposed draft price for the test is US$1,018.44.
Once finalised, this price will determine the amount Pacific Edge will be reimbursed for all patients with Medicare and Medicare Advantage insurance.
However, it is still subject to coverage approval by Pacific Edge's Medicare Administrative Contractor, Novitas.
The test is currently listed as non-covered on Novitas' Local Coverage Determination.
The company said the new price represents a meaningful increase compared to the existing US$760 CMS price of its tests, improving profitability and margin per test.
It plans to prioritise the migration from Triage to Triage Plus once coverage is established.
Pacific Edge expects to submit a reconsideration request for coverage of Triage Plus after the publication of its analytical validation and clinical validation studies.
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