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Introduction of Breast Imaging and Metastatic Step Therapy Legislation Will Benefit Thousands of Michiganders

Susan G. Komen Commends Bill Introductions; Urges Quick Passage

LANSING – Susan G. Komen®, the world’s leading breast cancer organization, applauds Representative Brenda Carter (D-Pontiac) for working with Komen to introduce legislation on two vitally important issues, removing financial barriers to breast imaging and eliminating step therapy drug protocols for metastatic cancer patients. In 2023, more than 8,980 people will be diagnosed with breast cancer and more than 1,370 will die of the disease in Michigan alone.

“This legislation can make an immediate impact for thousands of people who require diagnostic or supplemental breast imaging yet are unable to afford it and often forego the tests,” said Molly Guthrie, Vice President of Policy and Advocacy at Susan G. Komen. “Everyone should be able to access the treatments prescribed by their provider without burdensome insurance requirements, especially when it could mean the difference between a person’s life and death.”

HB 5084, introduced by Rep. Carter, would eliminate out-of-pocket costs for diagnostic and supplemental breast imaging (such as an MRI, ultrasound, diagnostic mammogram) when medically necessary and prohibit step therapy protocols for advanced, metastatic cancer patients.

Diagnostic and supplemental imaging exams can be extremely expensive and require people to pay high out-of-pocket costs – all before more expensive treatment even begins. A Komen-commissioned study found the costs to patients range from $234 for a diagnostic mammogram to more than $1,021 for a breast MRI. The cost of the test prevents individuals in Michigan from getting the imaging they require, making it difficult to detect their breast cancer as early as possible. 

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. Patients and physicians should have the opportunity to choose the best treatments and therapies without the burden of overly restrictive cost containment policies.

“I’m proud to sponsor House Bill 5084, which will improve insurance coverage to fund more access to early breast cancer detection, prevention and follow-up care. Plain and simple, these preventive solutions should be covered by insurance to protect Michiganders from delayed diagnosis and increased risk of breast cancer complications. And not catching breast cancer early with reliable, diagnostic medical protocol and tools can needlessly cost lives,” said Rep. Carter. “HB 5084 gives everyone a better fighting chance against breast cancer.”