Policy Impediments to Tuberculosis Elimination: Consequences of an Absent Medicare National Coverage Determination for Tuberculosis Prevention

Despite being preventable, tuberculosis (TB) continues to affect thousands of individuals in the US with an increasing incidence every year since the COVID-19 pandemic. Critical to TB elimination efforts is the scale-up of screening and treatment for the estimated 13 million Americans with TB infection. For the Medicare population, the implementation of TB preventive services is hampered by the lack of clear coverage of TB infection screening. Despite a consistent US Preventive Services Task Force (USPSTF) recommendation since 1996, TB infection screening does not have a Medicare national coverage determination, which would ensure consistent coverage across the US. All other USPSTF recommended preventive services for Medicare recipients have a national coverage determination, a broadly applicable clinical quality measure or are medications generally covered through Medicare Part D. The lack of a national coverage determination for TB infection screening is crucially a health equity issue with TB disproportionally affecting non-US-born and minoritized US-born persons. To address this important barrier to TB prevention, a request to Medicare for a national coverage determination for TB screening was submitted in early 2024.