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.*
A nurse looking at a tablet with an elderly couple.
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.‡

A doctor looking at the patient assistance calculator on a laptop.

Billing and coverage process

Because insurance coverage varies across the country and is based on medical policy and benefit design, it’s sometimes difficult for patients to understand the costs associated with testing. That's why we offer help assessing your situation.

Step 1

Your doctor orders a test

We check your insurance coverage, and when necessary, we’ll work with your doctor’s office and insurance company to submit a prior authorization. 

Step 2

Once your test results are ready, we bill your insurance

Your insurance company will send you an Explanation of Benefits (EOB), which includes whether you owe any out-of-pocket costs. (An EOB is not a bill. Because insurance coverage varies, we strongly encourage you to contact your insurer with questions about coverage and potential out-of-pocket costs.)  

Step 3

We'll help you with appeals if necessary

If your insurance denies payment, Exact Sciences will submit appeals on your behalf, if  appeals options are available.

Step 4

If you have any outstanding fees, you'll receive a bill

Once all actions with your insurance are complete, if you have any remaining balance, you'll receive a bill from Exact Sciences.

References

  1. Exact Sciences performs the services ordered and deemed medically necessary, regardless of network provider status.
  2. Genomic Health, Inc., an Exact Sciences company, is the billing entity for the Oncotype DX® and OncoExTra® tests. 
  3. Exact Sciences may change or update its program criteria at anytime, without notice. Eligibility is not guaranteed. Exact Sciences may require that a patient provide proof of financial need if their information is not already available to Exact Sciences.

Oncotype DX, Oncotype DX Breast Recurrence Score, Breast Recurrence Score, and Recurrence Score are registered trademarks of Genomic Health, Inc., a wholly-owned subsidiary of Exact Sciences Corporation. Exact Sciences is a registered trademark of Exact Sciences Corporation. All other trademarks are the properties of their respective owners.

The Oncotype DX Breast Recurrence Score test was developed, and the performance characteristics validated by Genomic Health, Inc., a wholly-owned subsidiary of Exact Sciences Corporation following College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA) regulations. The Oncotype DX Breast Recurrence Score test is performed at the Genomic Health Redwood City clinical laboratory. Exact Sciences clinical laboratories are accredited by CAP, certified under CLIA regulations, and qualified to perform high-complexity clinical laboratory testing. This test has not been cleared or approved by the US Food and Drug Administration or other notified regulatory authority.