As cancer screenings evolve, so should benefit plan design 

Earlier this year, the Biden Administration reignited the Cancer Moonshot initiative. The goal? To reduce the cancer death rate by at least 50% over the next 25 years. This announcement came after the American Cancer Society released estimates that new cancer diagnoses and cancer deaths in 2022 will hit the highest levels seen since at least 2007. One focus of the new initiative is to get Americans back on track after nearly 10 million cancer screenings were missed during the pandemic.

Covering the entire cancer screening process is critical to removing barriers to care

Colon and rectal cancer were the second-leading cause of cancer deaths in 2020, despite being one of the most treatable forms of cancer when detected early. Unfortunately, only about one half of Americans stick to the recommended screening schedule, at least partially due to the unpleasant prep required for colonoscopies. Non-invasive at-home tests are an important way to close these gaps of care. One study found that screening rates jumped by more than 1,000% when researchers sent take-at-home tests to patients overdue for testing.

Further, federal guidance has reaffirmed that all colonoscopies following a positive at-home colorectal screening test should be covered at 100%, even though they might be considered diagnostic rather than preventive which would traditionally make them subject to a plan’s deductible, coinsurance or copay amounts. Research conducted by University of Michigan’s Center for Value-Based Insurance Design has demonstrated that the elimination of out-of-pocket costs for the entire cancer screening process is critical in removing barriers to care. That’s why they continue to advocate for similar policy changes with respect to breast, lung and cervical cancer screenings.

Recognizing the value in catching cancer early, some employers are exploring ways to expand coverage options for these types of cancers. And, like colon cancer there are similar low-cost at-home tests for breast cancer, HPV and prostate cancer available for purchase, although not all have FDA approval at this time. Encouraging preventive screenings is an important way to keep your population healthy – and early detection may result in downstream plan savings.

New cancer screening tests bring hope – and questions

You’ve probably seen the headlines about the GRAIL Galleri test, a single blood test that screens for over 50 types of cancer, including many for which no screening tests currently exist. While the test does not currently have FDA approval, it has been found to be able to detect some cancers at an early stage. There have been rare instances of false positives (0.5%), which raises questions about the harm that false positive results can cause. It is also important to note that an absence of findings is not an absence of cancer. Use of these screening tests does not negate the need and importance of current recommended screenings, or a visit and review with a healthcare provider when suspicious symptoms appear.

A cancer diagnosis can be devastating for employees and their families. But the sooner cancer is detected, the better the chance of a good outcome.