Humana Medicaid adds ChemoFx coverage for gynecologic cancers

DataMeds AI said its Helomics lab won a Medicaid coverage determination for the ChemoFx assay in gynecologic cancers after review by Humana’s Medicaid Coverage Policy Adoption forum. The decision could expand access to the tumor-response test for certain Medicaid members and support broader adoption of the assay under CPT codes 81535 and 81536.

Why it matters: - Humana’s Medicaid policy can widen access to ChemoFx for patients with gynecologic cancers who may need chemotherapy guidance. - Coverage may also improve reimbursement prospects for DataMeds AI’s Helomics subsidiary and support commercial volume for the assay. - The policy decision matters because the test is positioned as a treatment-selection tool in cancers where options can be limited or difficult to optimize.

What happened: - DataMeds AI said Helomics Corporation received a Medicaid coverage determination for the ChemoFx Assay in gynecologic cancers. - Humana’s Medicaid Coverage Policy Adoption forum reviewed the medical coverage policy and incorporated ChemoFx into its Coverage Determination for Pharmacogenomics Testing. - The policy number is HUM-SC-2240-003. - The effective date is July 22, 2026.

The details: - ChemoFx is a commercially available chemoresponse test that measures how a patient’s live tumor cells respond to chemotherapy agents. - The assay is billed under CPT codes 81535 and 81536. - Under Humana’s Medicaid policy, members may be eligible for ChemoFx if they have gynecologic cancer such as cervical, endometrial, fallopian tube, gynecologic sarcoma, ovarian or primary peritoneal cancer. - The policy lists several qualifying situations, including rare cancer with no established treatment guidelines, use during initial biopsy or surgery, recurrent cancer, treatment-refractory disease, or inability to tolerate recommended treatment. - The assay is not currently covered under all Humana plans. - Helomics is a CLIA-certified clinical laboratory in Pittsburgh and is a wholly owned subsidiary of DataMeds AI. - DataMeds AI said Helomics previously invested in lab automation to improve commercial readiness. - DataMeds AI said ChemoFx has peer-reviewed clinical utility data supporting treatment outcomes in gynecologic cancers. - The company also pointed to a 2021 peer-reviewed publication on ChemoFx in gynecologic cancer and a 2015 peer-reviewed cost-savings study in epithelial ovarian cancer. - The company said ChemoFx has not been cleared or approved by the U.S. Food and Drug Administration because it is a laboratory-developed test. - Helomics’ innovation division, Predictive Oncology, combines annotated biobanks from more than 130 tumor types with artificial intelligence and multi-omic data to support drug discovery and development. - For more information, see the company profile and the Helomics website.

Between the lines: - The coverage win gives DataMeds AI a payer-policy milestone that can matter as much as clinical validation in driving test adoption. - The policy language suggests Humana is targeting patients where therapy selection is especially uncertain, including rare, recurrent and treatment-refractory cases. - DataMeds AI is also signaling a broader commercialization push by linking the coverage decision to label expansion and additional publication plans. - The company framed ChemoFx as potentially cost-effective in recurrent epithelial ovarian cancer, including scenarios where assay-guided therapy reduces treatment costs versus empiric selection.

What's next: - DataMeds AI said it is preparing additional data for publication to support label expansion. - The company said it sees an opportunity to evaluate ChemoFx in other difficult-to-treat cancers. - Broader payer adoption remains a key test for whether the Humana Medicaid decision translates into wider coverage beyond this policy.

The bottom line: - Humana’s Medicaid coverage decision gives ChemoFx a notable reimbursement foothold in gynecologic cancers and could help DataMeds AI push the assay further into routine oncology decision-making.