AGA President John Inadomi, MD, and former AGA President David Lieberman, ACS CAN and Fight CRC met with Assistant Secretary of Labor, Ali Khawar and representatives from the U.S. Department of Health and Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive non-invasive colorectal cancer (CRC) screening test.
The meeting was in response to an appeal sent to the three agencies, which provide guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.
“It is critical that patients have access to the full continuum of colorectal cancer screening options and that cost is not a barrier to completing screening. There is a problem here that we need the federal government to fix,” says John Inadomi, MD, president of AGA. “From a payment standpoint, insurers can’t cover only a stool test and consider that a complete colorectal cancer screening. If the test is positive, the required follow-up colonoscopy to look for and remove pre-cancerous growths must be covered as well.”
In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”
In order to ensure that privately insured Americans receive proper CRC screening, AGA, ACS and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive non-invasive screening test are part of the colorectal cancer screening process and thus patients should not face out-of-pocket costs when completing colorectal cancer screening.
Colorectal cancer remains the second leading cancer killer in the U.S. despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020, when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.