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The Medicare Appeals Process: Reforms Needed to Ensure Beneficiary Access

The incidence of cancer increases with age and thus the Medicare program is vitally important to millions of Americans who are undergoing active cancer ... services.  At the same time public and private payers increasingly employ a variety of measures to minimize their liability for paying for high-cost services, such as cancer therapies. As a result, cancer patients increasingly have to go through appeals or exceptions processes in order to ... save their lives.  To better understand how the Medicare program’s appeals process works for beneficiaries who have a history of cancer, ACS CAN released a paper analyzing  the existing appeals processes used by the Medicare program by walking through the Medicare Part A and B appeals ...

Prescription Drug Affordability Boards and the Impact on Cancer Care

Addressing the costs of cancer care is crucial to accomplishing the mission of the American Cancer Society Cancer Action Network (ACS CAN) to end cancer as we know it for everyone. ACS CAN has long fought for public ...

Survivor Views on Enhanced Premium Tax Credits

Overview: The American Cancer Society Cancer Action Network (ACS CAN) empowers advocates across the country to make their voices heard and influence evidence-based public policy change, as well as legislative and regulatory solutions that will reduce the cancer burden. As part of this effort, ACS CAN deploys surveys to better understand cancer patient and survivor experiences and perspectives, through our Survivor Views ... not aware of the ACA premium tax credits and just 25% are aware they are currently set to expire by the end of 2025. Detailed Survey Findings: Cost is a Significant Burden for Cancer Patients and Survivors Seventy-five percent of cancer patients and survivors surveyed are concerned about ...

National Screening Survey

Overview The American Cancer Society Cancer Action Network (ACS CAN) empowers advocates across the country to make their voices heard and influence evidence-based public policy change, as well as legislative and regulatory solutions to reduce the cancer burden. As part of this effort, ACS CAN deploys surveys to better understand cancer patient and survivor experiences and perspectives, through our Survivor Views ... percent of those who do not have a regular primary care doctor report having been more than a year behind on their recommended screenings. Cost is the Single Most Frequently Mentioned Reason for Falling Behind When asked the main reason for being behind on routine cancer screenings, ...

Step Therapy in Medicare Part D Oncology Drugs

... Drug Plans (PDPs), to control prescription drug spending. While UM is used to lower plan spending and premiums for beneficiaries, it can also make it more difficult for patients to access the prescriptions they need, especially high-cost oncology drugs. To better understand how UM is used in Medicare, the American Cancer Society Cancer Action Network (ACS CAN) engaged Avalere ... and UM by plan type. Differences in tiering occurred within Special Needs Plans (SNPs), which placed the four drugs on the specialty tier 45% of the time and the preferred brand tier 55% of the time. [1] All non-SNP MA-PDs and all standalone PDPs placed the four drugs on the specialty ...

Improving Access to Biomarker Testing

The knowledge and practice of precision medicine in cancer have been progressing rapidly and advances have led to targeted cancer therapies that can improve patient survival and quality life. Treatment with targeted therapy often requires diagnostic testing to analyze biological samples ... clinical use does not always follow, and testing rates lag behind clinical guideline recommendations. As highlighted in a recent ACS CAN survey of cancer patients and survivors, only one-third of respondents reported having biomarker testing. Of those who reported not receiving biomarker ...

The Facts About Medicaid and Cancer

Medicaid provides essential health coverage to millions of lower income individuals in the U.S. It is funded jointly by the federal and state governments. Because access to health insurance coverage is a key factor in preventing, catching and treating cancer, the American Cancer Society Cancer Action Network (ACS CAN) encourages policymakers to ensure that this vital health coverage program is available to people who need it, particularly those with cancer ... their Medicaid benefits. [10] The program has encountered significant obstacles, including high administrative costs: the program has already cost nearly $26 million to implement, with 90% of funding directed toward administrative expenses, including application processing and work ...

Cancer Patients and Survivors Overwhelmingly Agree Biomarker Testing Improved Their Treatment

Overview The American Cancer Society Cancer Action Network (ACS CAN) empowers advocates across the country to make their voices heard and influence evidence-based public policy change, as well as legislative and regulatory solutions that will reduce the cancer burden. As part of this effort, ACS CAN deploys surveys to better understand cancer patient and survivor experiences and perspectives, through our Survivor Views ... using a plan purchased privately such as through the marketplace. Nine percent of those who did not have biomarker testing say it was because of cost or coverage concerns. This is a significant improvement since the last time this question was asked in 2020, when 29% mentioned cost and ...

Survivor Views: Patient Satisfaction by Gender

Overview The American Cancer Society Cancer Action Network (ACS CAN) gives voice to cancer patients and survivors on critical public policy issues that affect their lives.  As part of this effort, ACS CAN deploys surveys to better understand cancer patient and survivor experiences and perspectives, through our Survivor Views ... as a result of their self-advocacy and follow-up. Seventeen percent felt they needed follow up care but did not seek it due to concerns about cost or coverage. Detailed Survey Findings: Women Twice as Likely as Men to Report Middling Ratings of Their Experiences Overall, the vast majority ...

Medicaid Work Requirements Jeopardize Cancer Patients & Survivors

... that provides comprehensive health coverage for certain individuals, including those with limited incomes and disabilities. The vast majority of those with Medicaid who can work already do so; nationally, 92% of individuals with Medicaid coverage under age 65 who do not receive Social Security disability benefits ... the program, far short of the state’s goal of 100,000 participants in its first year. [8] High Administrative Costs: The program has already cost nearly $26 million to implement, with 90% of funding directed toward administrative expenses, including application processing and work ...

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