Prior Authorization for Biomarker Testing Results in Therapy Delays For Most cancers Sufferers –

What You Ought to Know:

• Biomarker testing is a crucial instrument within the advancing world of precision most cancers therapy. In keeping with a brand new survey launched by CancerCare, a number one nationwide most cancers assist group, biomarker testing helped medical doctors tailor remedy for almost all of the respondent sufferers (93%) whose cancers had been examined over the previous three years. Two in 10 most cancers sufferers (20%) surveyed had been in a position to keep away from pointless chemotherapy and/or radiation and 10% turned eligible for a scientific trial.
• Regardless of the numerous and demonstrable advantages to surveyed sufferers, three out of 10 respondents (29%) who obtained biomarker testing didn’t have the check coated by their insurance coverage. Some survey respondents reported that biomarker check protection was initially denied and so they needed to combat to get it coated. Others needed to discover methods to pay out-of-pocket or search monetary help to cowl the price of the testing.

Addressing Therapy Delays in Most cancers Care

Sadly, medical insurance plans typically restrict most cancers sufferers’ entry to beneficial biomarker testing, impose burdensome prior authorization protocols, or require unaffordable cost-sharing, which may stop or delay most cancers sufferers’ entry to optimum remedies. Prior authorization, a major supply of roadblocks to well timed testing and therapy, was required by 1 / 4 (25%) of the most cancers sufferers surveyed.

Biomarker testing has been confirmed to be extraordinarily invaluable in figuring out the best remedy for eligible most cancers sufferers as a result of it helps them obtain the best remedies on the proper time whereas additionally saving cash and main to raised outcomes. Nonetheless, there are nonetheless gaps in medical insurance protection for this significant check. Sufferers and physicians could also be required to leap via hoops to get authorization after which, the fee sharing may be prohibitive.

“Even if biomarker testing has dramatically modified the way in which most cancers is recognized and handled, many insurers don’t present sufficient protection for the check,” stated Patricia J. Goldsmith, CEO of CancerCare. “Employers that don’t sufficiently cowl this testing of their insurance coverage create an actual danger that their workers won’t obtain the best, and typically, lifesaving remedy.”

Eleven states have enacted or are about to enact laws mandating that well being plans cowl biomarker testing for most cancers sufferers. The excellent news is that 18 extra states have launched biomarker protection laws, with the purpose of requiring that state-regulated private and non-private well being plans present constant protection for this testing.

Biomarker Testing is a Well being Care Fairness Challenge

Biomarker testing is more and more a well being care fairness difficulty in keeping with knowledge from current research. Analysis printed by the American Society of Medical Oncology exhibits important gaps within the fee of biomarker testing between Black and white lung and colorectal most cancers sufferers, which may result in disparities in scientific trial participation and hinder entry to the best remedies. A key approach to tackle these limitations is to broaden insurance coverage protection of biomarker testing, as beneficial by medical specialists.