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Free Prevention Loopholes Closed in Administration Guidance

Statement from American Cancer Society Cancer Action Network President Christopher Hansen

February 20, 2013

WASHINGTON, D.C. – February 20, 2013 – “Patients and consumers in the private insurance market should no longer face unexpected cost-sharing for preventive colon cancer screening tests that were supposed to be free under the Affordable Care Act. The Department of Health and Human Services (HHS) and the Department of Labor today issued guidance  that polyps removed during a routine screening colonoscopy should not affect the nature of the procedure and thus carry a co-pay. Previously, if a polyp was removed insurers were reclassifying the procedure and no longer considering it a preventive measure. This loophole meant patients could find themselves with an unexpected cost burden for a preventive service that was supposed to be free, because it carried an “A” rating by the United States Preventive Services Task Force.

“Evidence shows that even limited cost-sharing can be a deterrent from getting the test. Polyps left untreated can result in advanced stage colorectal cancer that is much more expensive to treat and difficult to survive. “The loophole that allows for reclassification from a preventive screening to a treatment therapy still exists in Medicare. U.S. Rep. Charlie Dent (R-PA) introduced a bill last year to close the loophole in Medicare and plans to reintroduce the same bill this year. The American Cancer Society Cancer Action Network (ACS CAN) advocated for the elimination of copays for this proven preventive service in both the private insurance market and in Medicare to ensure that families affected by cancer have access to this important prevention tool.  

“A report released last September by the American Cancer Society, the National Colorectal Cancer Roundtable and the Kaiser Family Foundation demonstrated how lack of guidance was leading to inconsistent application of cost-sharing for what should have been a free preventive care benefit in the private insurance market.

“The administration also offered guidance to close other preventive screening loopholes that led to unexpected cost-sharing for individuals with a family history of cancer. Specifically, the administration concluded that individuals with a family history of breast cancer should have access to both genetic testing and counseling at no cost if family history indicates the patient is at high risk for developing the disease. Previously, some insurers were only covering genetic counseling as a free preventive service, but the genetic test for the actual BRCA1 and BRCA2 genes, associated with higher incidence of breast and ovarian cancer, was potentially subject to significant cost-sharing.

“Access to affordable prevention is a critical step toward transitioning our health care system to one that focuses on wellness, rather than waiting to treat until a patient gets sick. ACS CAN applauds the administration for closing loopholes that undermined the intent of the law – to provide access to meaningful, affordable prevention services.”

For a link to full joint report illustrating the inconsistent application of cost-sharing for colonoscopies, visit: http://nccrt.org/wp-content/uploads/NCCRT.pdf.

ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.acscan.org.

FOR MORE INFORMATION, CONTACT:
Alissa Crispino or Steven Weiss
American Cancer Society Cancer Action Network
Phone: (202) 661-5772 or (202) 661-5711
Email: Alissa.Crispino@cancer.org or Steve.Weiss@cancer.org

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