ACOG has been engaged in proactive advocacy for NIPT coverage since the publication of the updated clinical guidance in October 2020. ACOG’s goal is to ensure payers are aware of the updated guidance, that coverage policies are revised to mirror the guidance, and that plans remove any prior authorization requirements.
ACOG’s Health Economics and Practice Management team has reached out to all national payers through a letter and followed up with conversations with medical directors, as requested. Subsequently, ACOG also coordinated with 34 ACOG Sections, the American Clinical Laboratory Association and the Coalition for Access to Prenatal Screening. While ACOG is continuing outreach with payers at the national and state levels, grassroots efforts are necessary to ensure access for all patients, regardless of payer policies.
The next two letters include language for obstetric clinicians and patients to send to state and local health plans. The letters are supported with evidence consistent with ACOG’s clinical guidance. We encourage you to add personal experience (without including protected health information) as it will strengthen your position. NIPT screening and testing should be a benefit for ALL patients without the unnecessary burden of prior authorization.
Please refer to the prior authorization denials appeal letter for assistance with denials.