Urges Bipartisan and Swift Passage, Allowing Women Equal Access to Quality Care
Susan G. Komen®, the world’s leading breast cancer organization, applauds Senator Annette Sweeney (R-District 25) for her leadership on two vitally important bills, diagnostic breast imaging and elimination of step therapy drug protocols for metastatic cancer patients. The proposed diagnostic breast imaging bill would eliminate out-of-pocket costs for diagnostic breast imaging following an abnormal mammogram. The metastatic step therapy bill would prohibit the use of step therapy protocols for metastatic breast cancer patients.
Millions of women throughout the United States can access free, preventive screening mammography under the Affordable Care Act (ACA). However, if the results of a mammogram reveal an abnormality, follow-up diagnostic exams (such as an MRI, ultrasound, diagnostic mammogram) are needed to determine if the patient has breast cancer. Those exams can cost hundreds to thousands of dollars in out-of-pocket costs – all before treatment even begins. An estimated 12 percent of patients who receive annual screening mammograms get called back for diagnostic imaging. SF 136 would eliminate this disparity in coverage. In Iowa, 2,710 women are estimated to be diagnosed with breast cancer in 2021 and 390 will die of the disease this year alone.
A Komen-commissioned study found the costs to patients for diagnostic tests range from $234 for a diagnostic mammogram to $1,021 for a breast MRI. Out-of-pocket costs are particularly burdensome to those who have previously been diagnosed with breast cancer, as diagnostic tests are often recommended rather than traditional screening mammography.
“This legislation is an important step forward for women in Iowa,” said Molly Guthrie, Senior Director of Public Policy and Advocacy at Susan G. Komen. “We see first-hand that women face hundreds to thousands of dollars in out-of-pocket costs for needed diagnostic imaging. As a result, many women do not seek care until the cancer has spread – making it deadlier and more expensive to treat. A woman should not have to choose between paying her electric bill or getting a medically necessary ultrasound. This life-saving legislation will ensure timely access to diagnosis and treatment.”
Step therapy, also referred to as “fail first,” requires a patient to first try a preferred (often generic alternative) drug prior to receiving coverage for the originally prescribed drug. Step therapy is a method of utilization management that health plans employ to control costs by beginning treatment with a cheaper drug therapy and then progressing to the newer, more costly treatments, only if necessary. SF 116 would eliminate step therapy protocols for metastatic breast cancer patients, those whose cancer cannot be cured. Patients and physicians should have the opportunity to choose the best treatments and therapies without the burden of overly restrictive cost containment policies.
“No patient should be forced to use a treatment option not preferred by their provider and then have that treatment fail them – all just to get the originally prescribed treatment. Insurance design should not dictate treatment protocols,” Guthrie added.
Backing these bills is part of Komen’s ongoing effort to support Iowans through public policy advocacy, as well as a broad suite of direct patient services and investments in breakthrough research. People in need can call Komen’s free Helpline and receive guidance to resources and emotional help from trained oncology social workers. In addition, Komen provides financial assistance through a national Treatment Assistance Program.