A new study published in Gastroenterology reveals a significant proportion of prescribed bowel preparation claims still include some out-of-pocket expenses for patients, despite the Affordable Care Act (ACA) requiring that colonoscopies and related services, including bowel preparation medications, be covered without cost-sharing.
Key takeaways:
- Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the U.S. While highly preventable through regular screening, uptake rates remain low: Only 59% of adults aged 45+ are up to date.
- In 2025, more than 150,000 people will be diagnosed with CRC, and over 50,000 people will die from the disease.
- Despite ACA provisions, 53% of commercial insurance claims and 83% of Medicare claims for bowel prep still involve patient cost-sharing.
- Even among Medicaid claims, where cost-sharing was less common, 8.3% still included out-of-pocket costs.
- The study highlights a troubling gap in policy enforcement that could lead patients to decline colon cancer screenings if better-tolerated low-volume bowel preparations are not covered.
AGA is actively speaking with CMS and legislators about this issue. Patients should not have any out-of-pocket costs for CRC screening, which includes bowel prep. Cost should not be a barrier to life-saving screening.
