Alleviating Patient Burden
Current law requires insurance companies to cover the cost of annual mammograms for women over the age of 40, without any cost to the woman. Unfortunately, individuals at a higher risk of breast cancer or those requiring follow-up imaging (e.g., diagnostic mammography, breast ultrasound, breast MRI) due to an abnormal mammogram result will likely be facing hundreds to thousands of dollars in patient cost sharing. Komen strongly supports policies that eliminate the out-of-pocket cost of these medically necessary tests.
Komen supports policies that improve accessibility and affordability of genetic counseling, genetic testing and genomic testing, so a person can fully understand their risk of developing breast cancer or to help guide treatment decisions.
Patient navigation services help a patient through the continuum of care, so they don’t get lost in a web of doctor visits, appointments and tests throughout their diagnosis and treatment. Komen supports an increase in coverage for these patient navigation services, reimbursement for the cost of the services and policies that make navigation accessible to more people.
Remove insurance barriers related to the treatment of cancer so that patients can receive the right treatment without burdensome processes and cost. These barriers include step therapy/metastatic step therapy protocols that require a preferred drug to fail a patient before they can access the originally prescribed drug. They also include out-of-pocket costs; prior authorization requirements; co-pay accumulators, which prevent a patient from applying a drug manufacturer’s assistance coupon toward their annual out-of-pocket maximums; and non-medical switching, in which an insurance company will switch a patient’s medication for reasons unrelated to health and more commonly related to cost.
Alleviating Patient Burden Priorities
- Eliminate patient cost-sharing for medically necessary diagnostic and supplemental breast imaging (e.g., diagnostic mammography, breast ultrasound, breast MRI)
- Improve accessibility and affordability of genetic counseling, genetic testing and genomic testing
- Increase patient navigation coverage, reimbursement and accessibility
- Remove insurance barriers related to cancer treatments (e.g., step therapy/metastatic step therapy protocols, non-medical switching, out of pocket costs, prior authorization, co-pay accumulator)