Washington, DC, & Charlottesville, VA – The Medical Imaging & Technology Alliance (MITA) and the Focused Ultrasound (FUS) Foundation today submitted comment letters largely supportive of the Centers for Medicare & Medicaid Services (CMS) proposed rule for the Medicare Coverage of Innovative Technology (MCIT) program.
First announced in September of this year, the CMS proposed rule would create a Medicare coverage pathway that would expedite patients' access to innovative medical devices with a Food and Drug Administration (FDA) "breakthrough" designation. The proposal represents a much needed and long overdue regulatory update that will help eliminate the lag time between FDA approval of a device or drug and the subsequent provision of Medicare coverage following approval of FDA-designated breakthrough devices. If finalized, the proposed rule would pair FDA breakthrough and CMS coverage to grant immediate, four-year Medicare coverage for medical devices or drugs deemed as "breakthrough."
"For years, breakthrough medical technologies– despite having received FDA approval– have faced a sometimes years-long process before achieving Medicare coverage," said Patrick Hope, Executive Director, MITA. "This system creates a 'Catch-22' scenario in which, without adequate coverage or reimbursement, access to an FDA approved therapy is limited to only those who can afford to pay out-of-pocket. Limited access means a limited ability to collect the same data needed to support reimbursement. The proposed rule would help eliminate this so-called 'valley of death' between FDA approval and subsequent Medicare coverage by giving beneficiaries faster access to breakthrough technologies that would otherwise be left in limbo."
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"By eliminating the gap between FDA approval and Medicare coverage for innovative medical devices, the proposed MCIT pathway would provide more certainty to manufacturers, more tools in clinicians' armamentarium to treat disease, and more universal treatment options for patients," said Jessica Foley, PhD, Chief Scientific Officer at the Focused Ultrasound Foundation.
While supportive of the MCIT proposed rule, both MITA and the FUS Foundation outlined further
recommendations to strengthen beneficiary access to innovative medical devices. For example, as discussed in the proposed rule, only a small number of technologies have received "breakthrough" marketing authorization by the FDA. Recognizing that this policy leaves numerous medical solutions out, MITA and the Foundation urged CMS to develop a more expansive list of criteria for inclusion in the MCIT program beyond the "breakthrough" designation. Doing so would help ensure efficient market access for advanced imaging solutions and software, novel radiopharmaceuticals and contrast agents, and high-intensity focused ultrasound therapies.