The Biden Administration released updated guidance on January 10th requiring private insurance providers to cover the cost of follow-up colonoscopies following a positive DNA stool test. The American Cancer Association, Fight Colorectal Cancer, The American Cancer Society Action Network, and the AGA had been pushing for this change since meeting with regulators from the U.S. Departments of Labor, Health and Human Services, and the Treasury.
“Now patients can choose the best colorectal cancer screening test for them without fear of a surprise bill. Patients have full coverage of the full screening continuum—from an initial stool or endoscopic test to a follow-up colonoscopy. Now that the financial barriers have been eliminated, we can focus on increasing screening so we can prevent cancer deaths,” John Inadomi, MD, President of the AGA said.
Screening changes
This new guidance expands on the updated requirements announced by the United States Preventative Services Task Force (USPSTF) in 2021, lowering the minimum age to begin CRC screenings from age 50 to age 45.
Colorectal cancer remains one of the deadliest forms of cancer in America, ranking second behind lung cancer. In 2018, 68.8-percent of eligible adults received their colorectal cancer screenings, but since the outbreak of the COVID-19 pandemic, screenings have declined by 86-percent.
Accessibility
A broader segment of the population will have access to screenings and screening locations with private insurance. Through continued efforts based on education and policy changes, the AGA and its partners hope to see a reduction of cancer’s impact on the population.
“Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer and more than 52,000 will die from the disease. But colorectal cancer is preventable when pre-cancerous polyps are found and removed through a colonoscopy. The announcement from the Tri-Agencies clarifying all private insurance plans must fully cover colonoscopies after a positive non-invasive stool test will save lives from colon cancer. ACS CAN will work to expand this coverage to traditional Medicare and Medicaid beneficiaries to help ensure all individuals who need a colonoscopy are able to access one.”
Anjee Davis, MPPA, President of Fight Colorectal Cancer, sees the updated guidelines as another step toward improving the quality of healthcare for all patients. Those in medically underserved communities will be impacted the most.
“This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs,” Davis said. “Ultimately, this will save lives and support the early detection of colorectal cancer.”
