How Lumos Secured Medicare Coverage for 70% of US FebriDx Tests
Lumos Diagnostics has secured Medicare reimbursement for its FebriDx test from a fifth contractor, covering more than 70% of US Medicare payments and advancing its commercial reach.
- Medicare reimbursement secured from fifth MAC, WPS Health Solutions
- Coverage now spans five of seven MACs, representing 70%+ of US Medicare payments
- Reimbursement rate set at US$41.38 per FebriDx test, retroactive to May 1, 2025
- Negotiations ongoing with remaining two MACs to achieve full Medicare coverage
- Medicare adoption expected to influence private insurance reimbursement decisions
Lumos Advances Medicare Reimbursement Milestone
Lumos Diagnostics (ASX: LDX) has announced a significant step forward in the commercialisation of its rapid point-of-care diagnostic test, FebriDx, by securing Medicare reimbursement coverage from a fifth Medicare Administrative Contractor (MAC) in the United States. The new coverage, granted by WPS Health Solutions, is retroactive to May 1, 2025, and sets the reimbursement rate at US$41.38 per test.
WPS Health Solutions manages Medicare payments across several Midwestern states, including Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan. This addition brings Lumos’ Medicare coverage to five out of seven MACs, representing over 70% of total US Medicare payment coverage. Previously, Lumos had secured coverage from Novitas, Palmetto, First Coast Service Options, and Noridian Healthcare Solutions.
Strategic Importance of Medicare Coverage
Medicare reimbursement is a critical validation for diagnostic technologies like FebriDx, as it not only facilitates patient access but also often sets a precedent for private insurance payors. Lumos’ expanding Medicare footprint significantly enhances its ability to reach a broad patient population, which is essential for driving adoption and commercial success in the competitive US healthcare market.
Doug Ward, Managing Director of Lumos Diagnostics, emphasised the company’s commitment to integrating FebriDx into clinical care pathways that benefit patients and deliver value to the healthcare system. He highlighted the ongoing efforts to secure coverage from the remaining two MACs and private insurers, aiming for nationwide access and broad clinical adoption.
Looking Ahead: Adoption and Commercialisation Challenges
While Medicare coverage is a major milestone, Lumos acknowledges that long-term commercial success will depend on demonstrating clear clinical benefits, improving diagnostic and treatment efficiency, and proving economic value to healthcare providers. The company’s progress in these areas will be closely watched by investors and healthcare stakeholders alike.
As negotiations continue with the remaining MACs and private payors, the pace and extent of FebriDx’s market penetration remain key uncertainties. However, this latest reimbursement win solidifies Lumos’ position as a growing player in the US point-of-care diagnostics space.
Bottom Line?
Lumos’ expanding Medicare coverage marks a pivotal step, but full US market penetration hinges on finalising remaining contracts and private payor adoption.
Questions in the middle?
- When will Lumos secure reimbursement from the remaining two Medicare Administrative Contractors?
- How quickly will private insurance payors follow Medicare’s lead in covering FebriDx?
- What clinical and economic data will Lumos present to accelerate broader adoption?
