As a medical practitioner in [NAME OF STATE], I order cell-free DNA (cfDNA)-based noninvasive prenatal screening (NIPS) for my pregnant patients, as these tests are part of essential prenatal care services. I applaud [NAME OF PLAN] for covering cfDNA-based NIPS for its high-risk patients to detect a range of fetal chromosomal abnormalities from a simple maternal blood sample. However, there is compelling clinical evidence that NIPS is a medically necessary screening procedure for all pregnant women who choose to pursue aneuploidy screening—regardless of their risk factors, income, age, or geographic location.
Compared to traditional screening tests, cfDNA-based NIPS has markedly lower false positive rates that provide significantly improved positive predictive values (PPVs); this means that the number of unnecessary invasive confirmatory procedures triggered by positive screening results is much lower for NIPS compared to traditional methods. Additionally, cfDNA-based NIPS has extremely low false negative rates for the common aneuploidies, resulting in high negative predictive values (NPVs) that approach 100%.
Commercial health plans representing more than 100 million lives in the United States have already updated their medical policies to cover NIPS for all pregnancies, regardless of risk. I hope you will consider the information provided here and update your medical policy to provide access to NIPS as a medically appropriate option for all your pregnant enrollees.
[NAME OF SENDER]
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