This article is for primary care providers caring for our Medicare Advantage, FEP, and certain commercial members
Earlier this fall, we sent letters to our members who may be due for a colorectal cancer screening to let them know that they’re eligible to receive a Cologuard®' kit. Cologuard is a covered, non-invasive screening option that members can complete from the comfort of their home. It is available at a $0 copay.
Using our claims data, we identified members who appear to be due for colorectal cancer screening and may be appropriate for a Cologuard screening.1 Members with claims for “high risk conditions” (for example, inflammatory bowel disease, family history of malignancy) were excluded from this program.
We’re working with Exact Sciences, an independent health screening organization, to send Cologuard kits to identified members. Identified members received a letter notifying them that they are eligible to receive a kit. The letter included explicit instructions about who should or should not complete the screening.
Cologuard should not be used if the member:
Medicare Advantage and Federal Employee Program (FEP) members were automatically sent a kit if they did not opt out before September 30, 2024. Kits were mailed early in October.
Commercial members must request a kit online or by calling Exact Sciences.
Following instructions included in the kit, members will complete the test and mail their samples back to Exact Sciences for analysis. Exact Sciences will mail results to the member within two weeks after receiving the Cologuard sample. You will also receive these results directly from Exact Sciences automatically via mail or fax if the member has identified you as their PCP within our systems. If your practice uses EPIC, you can also leverage EPIC Care Everywhere to retrieve results for your patients.
If the member does present an increased risk, we’ll point them back to you to review all screening options that are available to them. Exact Sciences will also reach out to members with a positive screening and encourage those members to follow up with their PCP.
1. INDICATIONS AND IMPORTANT RISK INFORMATION: Cologuard is intended to screen adults 45 years of age and older who are at average risk for colorectal cancer by detecting certain DNA markers and blood in the stool. Cologuard is not a replacement for colonoscopy in high-risk patients. Patients with a positive test result should be referred for colonoscopy. A negative test result does not confirm the absence of cancer. Patients with a negative test result should discuss with their doctor when they need to be tested again.
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