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High Deductible Health Plans Cause Extreme Spikes in Cost
The Problem Most patients experience spikes in their health care costs around the time of a cancer diagnosis as they pay their deductible and out-of-pocket maximum. For patients on high deductible plans, this spike can mean bills due for several thousands of dollars within one month. High deductibles often cause individuals to delay or forego care due to cost, which means it may take longer to get a cancer diagnosis and begin life-saving care. And the number of people enrolling in high deductible ...
Some Patients Lack Access to Lower-cost Drug Alternatives
The Problem Many cancer patients take multiple drugs as part of their treatment – often for many months or years. While drugs are not the only costly part of cancer treatment, finding ways to reduce these costs for patients and payers will significantly reduce the overall cost burden of cancer. Biosimilars and generics are lower cost alternative versions to some cancer drugs that may become available after the ... and her insurer nearly $75,000 over two years. If she had access to a biosimilar, those overall costs would have decreased by over 20%. ACS CAN Fights for Solutions ACS CAN supports efforts to ensure biosimilar and generic drugs are available to patients either through prescription from ...
ACS CAN Proposal For Regulatory Safe Harbor for Financial Support of Patients on Trials
In response to an annual request from the Department of Health and Human Services (HHS), ACS CAN has proposed a safe harbor from the Anti-Kickback Statute that would allow trial sponsors to provide financial support to trial participants to offset non-medical costs. ACS CAN Proposal For Regulatory Safe Harbor for Financial Support of Patients on Trials ...
Survivor Views: Surprise Billing and Prescription Cost and Coverage Survey Findings Summary
Overview: The American Cancer Society Cancer Action Network (ACS CAN) established Survivor Views in January 2019. The project has established a cohort of 3,055 cancer patients and survivors diagnosed with and/or treated for cancer within the last five years who are willing to share their opinions ... In October 2019, Survivor Views conducted a cohort survey focused on their experiences accessing and paying for cancer care, including the cost of prescription drugs and their experiences receiving surprise bills. One thousand three hundred and ninety-two cohort members responded to ...
ACS CAN Comments on Notice of Benefit and Payment Parameters proposed rule for plan year 2027
On Friday, March 13, 2026, ACS CAN filed comments in response to the Notice of Benefit and Payment Parameters proposed rule for plan year 2027. We offered comments on the ... Adequacy Standards Permitting Plan-Level Adjustments for Multi-Year Catastrophic Plans Multi-Year Terms for Catastrophic Plans to Improve Health Cost Sharing for Bronze and Catastrophic Plans Standardized Plan Options Essential Community Provider Standards for Network Plans and ...
Post Braidwood Coverage of USPSTF Recommendations
... 30, 2023, Judge O’Connor released a final opinion on remedies in Braidwood Management vs. Becerra , a case regarding the constitutionality of the ACA’s coverage of United States Preventive Services Task Force (USPSTF) recommended preventive services. [1] The ACA added section 2713 to ... Health Service Act (“Section 2713”) which requires, among other things, that certain plans cover USPSTF A and B recommended services with no cost-sharing. In his final opinion, Judge O’Connor ruled that plans would only be required to cover USPSTF A and B recommended services with no ... preventive services that existed as of March 23, 2010, discount the latest evidence around effective cancer prevention and early detection. ACS CAN created a chart comparing the current USPSTF recommendations to those that were in place as of March 23, 2010, showing the differences in the ...
ACS CAN Comments on March-In Rights Framework
In response to a request from the National Institute of Starndards and Technology (NIST), ACS CAN has offered comments on the use of march-in rights to address drug costs. ACS CAN Comments on March-In Rights Framework ...
ACS CAN Supports the Find It Early Act (H.R.3086)
Background Breast cancer is the second most diagnosed cancer among women in the U.S. and the second leading cause of cancer death among women after lung cancer. In 2023, an estimated 297,790 women in the U.S. will be diagnosed with invasive breast cancer, and ... Black women are more likely to experience longer intervals between mammograms and between abnormal results and follow-up. Some insurers apply cost sharing when initial breast cancer screening requires additional follow-on testing to determine whether an individual has cancer, or if dense ... and diagnostic services include but are not limited to 2D or 3D mammograms, breast ultrasounds, or breast magnetic resonance imaging. ACS CAN’s Position ACS CAN supports H.R. 3086 to increase access to no cost breast cancer screening, diagnostic and follow-up testing. ACS CAN ...
ACS CAN Factsheet: State Data on Health Care Tax Credits
... those who do not yet know they have cancer) need. Enrollees in Marketplace plans have access to evidence-based preventive services (without any cost sharing), prescription drug coverage, a network of doctors (including specialists like oncologists), emergency services, laboratory services, and other services cancer patients need. This factsheet provides data on the percentage and number of people in each state enrolled in a Marketplace plan. ACS CAN Factsheet: State Data on Health Care Tax Credits ...
Out-of-Pocket Spending Limits Are Crucial for Cancer Patients & Survivors
... to afford their treatments – even when they have health insurance. Current law establishes a limit on what most private insurance plans can require enrollees to pay in out-of-pocket costs. [1] These limits protect patients from extremely high costs and are essential to any health care system that works for cancer ... care physician, and $30 every time she sees her oncologist, who is considered a specialist. Co-insurance – a fixed percentage of the total cost of a treatment an enrollee pays. For example, a cancer drug costs $100 total per prescription filled and the patient’s plan has a 20 ...
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