Veracyte (VCYT) Announces CMS Will Maintain Reimbursement Rate for Afirma GEC

November 22, 2016 7:08 AM EST

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Veracyte, Inc. (Nasdaq: VCYT) announced that the Centers for Medicare and Medicaid Services (CMS) has released its revised final 2017 Medicare reimbursement rate for the company's Afirma Gene Expression Classifier (GEC). As a result of Veracyte's reconsideration request, the agency has determined the genomic test's current rate of $3,200 will be maintained in 2017. This final rate replaces the previously released lower "gapfill" amount and will go into effect on January 1, 2017.

"We are pleased with CMS's decision to uphold the Afirma GEC Medicare reimbursement rate that the agency has been paying since 2012," said Bonnie Anderson, Veracyte's president and chief executive officer. "Moreover, with final Medicare rates in place for 2017 and market-based pricing to begin in 2018 through the Protecting Access to Medicare Act, we believe that Medicare reimbursement for the Afirma GEC will now remain stable for the foreseeable future."

The rate announced today follows Veracyte's submission to CMS of a reconsideration request expressing its concern that the previously released lower gapfill rate was not supported by CMS's own gapfill regulatory criteria. Through the gapfill process, the price of a test is determined by the median price submitted by each of CMS's Medicare Administrative Contractors (MACs).

Beginning January 1, 2018, through the Protecting Access to Medicare Act (PAMA), Medicare reimbursement for advanced genomic tests such as the Afirma GEC will be based on the median price paid by commercial payers, which Veracyte calculates as above $3,200 for the Afirma GEC. Under PAMA, the new market-based Medicare rate will override any prior rate. Medicare represents approximately 20 percent of Afirma GEC test volume.

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