Coverage
Supporting your access to information
We’re committed to helping you make more confident and informed decisions about your cancer care so we strive to get access and coverage for our tests.*
The Breast Recurrence Score® test is well covered
86% of patients paid $0 91% paid less than $100*
*This calculation includes patients with Medicare, Medicare Advantage, Medicaid, Managed Medicaid, and commercial insurance. Patients with high-deductible plans may receive a bill for most or all the cost of the Breast Recurrence Score test if they have not satisfied their deductible. The numbers cited are based on historical patient billing data from 1/2/2024 to 12/31/2024. Rates of coverage vary by state and region. Exceptions for coverage may apply. Exact Sciences strongly encourages your patient to contact their insurer with questions about Oncotype DX Breast Recurrence Score test coverage.
Employer-sponsored or commercial insurance
We work with insurance companies to establish coverage for the Oncotype DX Breast Recurrence Score test
- While most commercial carriers cover the Oncotype DX Breast Recurrence Score test for eligible patients, coverage varies by product and your specific plan.
Contact our Care team to get help assessing your individual plan. - Exact Sciences
† is an in-network provider with many health plans, including Aetna, Anthem, Cigna, Humana, and UnitedHealthcare.
Medicare, Medicare Advantage and Medicaid
$0 financial responsibility for Medicare fee-for-service (FFS) when coverage criteria are met
- Fee For Service Medicare and Medicare Advantage plans cover the Oncotype DX Breast Recurrence Score test for eligible members.
- Medicare Advantage, which is provided by commercial insurance companies, may have different financial responsibility compared to Medicare FFS.
The 14-Day Rule
- Medicare FFS has specific date of service reporting requirements for laboratory tests, and the technical component of physician pathology services, ordered for Medicare patients (commonly known as the “14-Day Rule”).
Download our Provider 14-day Rule Guide (PDF)
Exact Sciences Patient Assistance Program
Exact Sciences believes that everyone should have the opportunity to be as healthy as possible, no matter who they are, where they live, or how much money they make.
We’ll work with patients to help them understand their coverage and payment options, including those who are uninsured or underinsured. Our estimator tool can help patients understand if they qualify for assistance.
