Bethesda, MD (June 18, 2025) — 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, according to a new paper published in Gastroenterology.
Key findings:
- 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.
Contact for media: Annie Mehl, media@gastro.org, 301-272-0013
About the AGA Institute
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, AGA represents members from around the globe who are involved in all aspects of the science, practice, and advancement of gastroenterology. The AGA Institute administers the practice, research, and educational programs of the organization. www.gastro.org
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