Patient access to colorectal cancer screening

AGA position: Reduce financial barriers to colorectal cancer screenings for Medicare beneficiaries

Passage of the Affordable Care Act (ACA) marked a major victory in the fight against cancer. The law waives the coinsurance and deductible for many colorectal (CRC) cancer screening tests , including colonoscopy, sigmoidoscopy, fecal immunochemical test (FIT) and fecal occult blood testing (FOBT). However, due to the unique nature of colonoscopy, many patients wind up paying out of pocket if the screening turns therapeutic. Congress recently passed a new law that will fix the Medicare screening colonoscopy loophole in 2022 and gradually phase out the coinsurance between 2022 and 2030.

While AGA is thrilled with the coinsurance fix, barriers along the screening continuum remain, reducing patients’ access to and utilization of CRC screenings. Currently, CMS limits its coverage of screenings to the first screening conducted. If a patient needs a follow up colonoscopy based on a positive or inconclusive non-invasive screening, the patient is then responsible for the necessary colonoscopy.. AGA urges CMS to use its authority to define the screening continuum and correct this lapse in CRC screening coverage for Medicare patients.

Is your colonoscopy covered? Read this patient resource and find out what you can expect to pay.

Patient Impact

Cost sharing creates financial barriers, which discourages the use of recommended preventive services. This could have a major impact on CRC screenings since 31.2% of U.S. adults age 50 to 75 years are not up to date on their CRC screenings. The COVID-19 pandemic has also greatly impacted the number of patients being screened. Across the U.S., providers saw a 90% decrease in screening colonoscopy and an 85% decrease in FIT.

Bottom line: Colorectal cancer can be prevented through screening and surveillance. Patients should be incentivized, through the elimination of cost sharing, to access CRC screenings. Additionally, the preventive screening benefit has contributed to the decline in colorectal cancer rates in our country and this benefit should be preserved in any future health care reform legislation.

1. Sec. 4104 of the “Patient Protection and Affordable Care Act” (ACA) waives the beneficiary coinsurance and deductible for covered preventive services that have a grade “A” or “B” from the U.S. Preventive Services Task Force (USPSTF). Colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT) have all been assigned an “A” rating from the USPSTF for adults beginning at age 50 and continuing until age 75.

2.https://www.cdc.gov/cancer/colorectal/statistics/index.htm#:~:text=The%20percentage%20of%20U.S.%20adults,adults%20screened%20for%20colorectal%20cancer

3. Patel, S., Issaka, R. B., Chen, E., & Somsouk, M. (2021). Colorectal Cancer Screening and COVID-19. The American journal of gastroenterology, 116(2), 433–434. https://doi.org/10.14309/ajg.0000000000000970