While colorectal cancer is the second-leading cause of cancer-related death in the U.S., and it is highly preventable for patients who undergo regular colonoscopy screenings, only 59% of U.S. adults over 45 are currently up to date on their screenings.
In addition, over 50,000 people will die from colorectal cancers in 2025. While the ACA requires that insurers cover colonoscopies and related services, including bowel preparation medications, 53% of commercial insurance claims and 83% of Medicare claims for bowel prep still involve patient cost-sharing, according to a June 20 study published in Gastroenterology.
Colonoscopy screenings are often avoided due to out-of-pocket costs and hesitancy toward bowel prep, with even minimal out-of-pocket costs associated with lower screening uptake in patients.
The study reviewed medical and prescription claims data from May 2022 to April 2023 for commercial, Medicare Part D and Medicaid colonoscopy claims.
A total of 2,593,079 prescription drug claims were analyzed: 52.9% from commercial plans, 35.0% from Medicare Part D plans and 8.3% from Medicaid plans. The remaining 3.8% comprised other payers, including health insurance exchange plans, and were excluded from this analysis. Among these, 53% of commercial claims had out-of-pocket costs greater than $0, compared to 83% of Medicare Part D claims and 27% of Medicaid claims.
The study shows that a significant proportion of prescribed bowel preparation claims — 53% for
commercial plans and 83% for Medicare — still involve patient cost-sharing, indicating noncompliance with ACA guidelines for CRC screening. Commercial and Medicaid plans showed higher compliance with the ACA mandate compared to Medicare.
While nearly half of commercial patients and nearly three-quarters of Medicaid patients incurred zero out-of-pocket costs for their bowel preparation, only 17% of Medicare beneficiaries received their preparations without cost-sharing.
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