AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.
The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.
In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”
To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.
Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.
