Access to Health Care

ACS CAN advocates for policies that provide access to treatments and services people with cancer need for their care - including those who may be newly diagnosed, in active treatment and cancer survivors.

Access to Health Care Resources:

These comments were submitted by ACS CAN to the U.S. Department of Health and Human Services regarding changes to the template Summary Plan Document that health insurance plans must provide to consumers.

In a letter to the National Association of Insurance Commissioners (NAIC), ACS CAN and other organziations provided specific comments to provide greater consumer protections and improvements to  the NAIC's Health Carrier Prescription Drug Benefit Model Act (Formulary Model Act). 

ACS CAN filed comments on the 2017 Notice of Benefit and Payment Parameters, including issues related to Medicare notices, standardized plan option designs, and network adequacy.

ACS CAN filed comments supporting the Internal Revenue Services' proposed clarification requiring plans to provide coverage for physician services and inpatient hospitalization in order to qualify as minimum value coverage. 

ACS CAN filed comments on the Medicare CY2016 Physician Fee Schedule, supporting CMS' proposals to establish a separate payment for collaborative care services and provide reimbursement for advanced care planning services.

This paper explores from a cancer patient’s perspective the adequacy of provider networks, the transparency of provider network information for the new qualified health plans (QHPs) offered in the Marketplace and the availability of out-of-network coverage.

ACS CAN provided comments on the proposed rule implementing changes to the Summary of Benefits and Coverage (SBC) and the Uniform Glossary in which we urged the Tri-Agencies to include a high-cost coverage example (specifically a breast cancer example) in the SBC, to require the inclusion of premium information on the first page of the SBC, and to eliminate the current coverage calculator and require plans to use actual plan data when providing coverage examples.

ACS CAN provided comments on the proposed rule implementing changes to the Medicare Shared Savings Program in which we urged CMS to provide additional beneficiary education and require greater specificity on wasy to improve care coordination for beneficiaries.

Despite the fact that US cancer death rates have decreased by 26 percent from 1991 to 2015, not all Americans have benefited equally from the advances in prevention, early detection, and treatments that have helped achieve these lower rates.

Prescription Drug Affordability Resources:

ACS CAN comments to Secretary Alex Azar on Drug Rebate Proposed Rule

Many cancer patients have difficulty affording the cost of their prescription drugs, regardless of whether they are insured.  This is especially true for newer drugs that do not have a generic equivalent.  Many programs exist to help patients afford their medication.  This fact sheet focuses on two of these – patient assistance programs and discount coupons.  

Biological drugs, commonly referred to as biologics, are a class of drugs that are produced using a living system, such as a microorganism, plant cell, or animal cell. Like all drugs, biologics are regulated by the United States Food and Drug Administration (FDA).

Pharmacy benefit managers (PBMs) are entities that administer prescription drug programs for many private, public, and employer health insurance plans. PBMs establish pharmacy networks, negotiate prices with pharmaceutical manufacturers on behalf of their clients, and provide basic claims administration.

For an individual with specific health care needs – like cancer patients and survivors – the drugs covered by a health plan and corresponding cost sharing for each drug is important information when choosing health insurance. However, to make an informed choice, formulary information must be disclosed to the individual.

Prescription drugs are often less expensive in other countries. This is due to a variety of factors. There have been efforts at the state and federal level to allow individuals to purchase lower cost prescription drugs from other countries and import these products into the United States for personal use.

New breakthroughs in cancer research are making more life-saving drug therapies available. Keeping these therapies affordable for patients is imperative. Prohibitive cost sharing for prescription drugs can cause patients to skip dosages, split pills or stop taking their medications entirely, which reduces the effectiveness of their treatment.

Currently, Medicare part D is administered entirely by private plans that follow guidelines set by CMS. Policymakers propose allowing the Secretary of Health and Human Services to enter negotiations between pharmaceutical manufacturers and Part D plans in an attempt to lower prescription drug prices.

Most health insurance plans that cover prescription drugs use formularies to categorize the drugs the plan will cover and determine the amount of patient cost sharing. Divided into “tiers”, the higher the tier, the higher the share of cost for patients.

Private Health Insurance Resources:

ACS CAN comments to Steven Mnuchin and Seema Verma on Iowa's 1332 Waiver

ACS CAN Comments on Massachusetts 1332 Waiver

ACS CAN Comments on Oregon 1332 Waiver

ACS CAN Comments on Iowa 1332 Waiver

ACS CAN submitted comments on the ACA market stabilization rule.

ACS CAN Comments on Special Enrollment Period Verification Pilot Program

ACS CAN Comments on Short-Term Policies

ACS CAN Recommendations for Updating the NAIC's Managed Care Plan Network Adequacy Model Act.

ACS CAN Comments on Proposed Changes to Special Enrollment Periods

Costs and Barriers to Care Resources:

Despite the fact that US cancer death rates have decreased by 26 percent from 1991 to 2015, not all Americans have benefited equally from the advances in prevention, early detection, and treatments that have helped achieve these lower rates.

Adequate and sustained investments and improvements in the prevention and early detection of disease are essential to refocusing the health care system on wellness.

Ensuring access to evidenced-based cancer screenings and quality treatment is critical to the fight against colorectal cancer. 

Our nation’s health care system is one of the most expensive in the world. Yet the quality of care we deliver to our citizens continues to lag behind that of other industrialized nations. 

Approximately 160 provisions in the final health care legislation will directly impact the millions of Americans who have or will face cancer. The following is a list of the most important provisions for the cancer community:

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Medicaid Resources:

ACS CAN CMS Comments on Massachusetts 1115 Demonstration Waiver

ACS CAN CMS Comments on Maine 1115 Demonstration Waiver

ACS CAN CMS First Comments on Massachusetts 1115 Demonstration Waiver

ACS CAN CMS Comments on Arkansas 1115 Demonstration Waiver

ACS CAN CMS Comments on Wisconsin 1115 Demonstration Waiver

ACS CAN, the American Heart Association, the American Diabetes Association released a joint statement providing principles for any entitlement reform proposal.

ACS CAN, the American Heart Association, the American Diabetes Association released a joint statement in support of the Medicaid program, noting that any reforms should improve the value of care provided under the program and should not reduce access for Medicaid beneficiaries.

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