MOST PATIENTS INCUR COSTS FOR COLONOSCOPY PREPARATION THAT THEY SHOULDN'T HAVE TO PAY

New data underscores the need for affordable, effective bowel preparation medications

MINNEAPOLIS, July 2, 2024 /PRNewswire/ -- A new study reveals that many patients are still paying out of pocket for bowel preparations needed for colonoscopy, despite a federal law that says these should be covered by insurance. The study, led by Dr. Eric D. Shah from the University of Michigan and his team, highlights the unnecessary financial burdens that can affect patient compliance with essential colorectal cancer (CRC) screening.  

The study, which analyzed nearly 2.6 million insurance claims from May 2022 to April 2023, looked at how many patients paid for bowel prep medications needed for colonoscopy. Claims came from both commercial insurance plans and Medicare Part D.

Overall, when considering that nearly 50% of patients are cost-shifted toward the use of non-FDA approved over-the-counter regimens, the data suggest that only 17% of patients pay zero for their bowel preparation for screening colonoscopy. Of the prescription claims analyzed, only 36% had no out-of-pocket costs. Additionally, high-volume preps were more likely to be free compared to new, low-volume or tablet preparations. However, when patients did pay, high-volume preps cost a median of $10, while low-volume preps cost $60. For Medicare Part D, only 25% of high-volume preps were free, compared to 10% for low-volume preps.ⁱ

The Colon Cancer Coalition, a national nonprofit committed to helping increase screening and prevention for CRC, is raising awareness of this issue, emphasizing the need for affordable and effective bowel preparation medications.

"As advocates for colorectal cancer screening and prevention, it's disheartening to see that so many patients are responsible for at least a portion of the cost of bowel preparation medication required for colonoscopy," said Chris Evans, President, Colon Cancer Coalition. "Equally as frustrating is that patients are paying even more for new, more modern, low-volume or tablet bowel preps that have been proven more effective and tolerable. All patients should have the ability to choose a quality bowel prep that works best for them, regardless of financial situation. Reducing barriers to quality prep, including cost, is important in ensuring more patients undergo this life-saving procedure."

The Affordable Care Act (ACA) requires that certain preventative services, including CRC screening, must be covered by insurance plans without cost-sharing for patients.ⁱⁱ This means that patients should not have to pay for these services to ensure that financial barriers do not prevent patients from undergoing necessary screenings for CRC.ⁱⁱ Unfortunately, prescription bowel prep for screening colonoscopy is still subject to cost sharing for most patients, running contrary to the ACA's mandate, and to the detriment of patients.

To learn more about the study, visit eposters.ddw.org, for more about patient choice and options for colonoscopy prep or coloncancercoalition.org.

About Colon Cancer Coalition
The Colon Cancer Coalition is dedicated to encouraging screening, reducing barriers to access, and raising awareness of the signs and symptoms of colorectal cancer. The organization's signature Get Your Rear in Gear^® event series is volunteer-driven in communities across North America. Annually, the Colon Cancer Coalition grants over $1 million dollars to local communities to build and sustain programs promoting prevention, on-time screening, and quality-of-life research, as well as patient support efforts for those living with this disease. By making the words colon, colorectal and colonoscopy a part of everyday language, we believe we can overcome the fear and decrease deaths from this largely preventable cancer. For more information visit ColonCancerCoalition.org.

For further information, contact:
Logan Campbell, HAVAS Red
[email protected]
724-987-2781

Erin Peterson, Colon Cancer Coalition
[email protected]
651-247-4023

References:
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ⁱ Shah, E. D., Calderwood, A. H., & Halberg, D. L. (2024, May). Most patients have out-of-pocket costs for colon preps associated with CRC screening, contrary to the ACA mandate: A real-world analysis from a large dataset. Poster presented at Digestive Disease Week, Washington, D.C.
ⁱⁱ U.S. Department of Health and Human Services. (2016, April 20). FAQs about Affordable Care Act implementation (Part 31). https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/FAQs%2031_Final%204-20-16.pdf

SOURCE Colon Cancer Coalition