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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:

A critical factor for eliminating disparities and ensuring health equity is the guarantee that all people have access to quality, affordable health care.

The American Cancer Society Cancer Action Network (ACS CAN) believes everyone should have a fair and just opportunity to prevent, detect, treat, and survive cancer. No one should be disadvantaged in their fight against cancer because of income, race, gender identity, sexual orientation, disability status, or where they live. From preventive screening and early detection, through diagnosis and treatment, and into survivorship, there are several factors that influence cancer disparities among different populations across the cancer continuum.

In 2003, Congress passed the Medicare Modernization Act (MMA), which created an outpatient prescription drug benefit in the Medicare program. Known as Part D, the prescription benefit is operated exclusively through private insurance plans that contract with Medicare. To ensure that beneficiaries have coverage for the drugs they need Part D plans are required to cover at least two drugs in each therapeutic class. A therapeutic class is a group of medications that are used to treat the same condition. 

Our latest Survivor Views survey sees increases in biomarker testing since the question was last asked three years ago along with reduced cost and coverage barriers in that time. Cancer patients and survivors describe the benefits and overwhelmingly agree biomarker testing gave their providers information that improved their treatment. 

The nation’s drug shortage crisis continues to affect cancer patients and survivors with 1 in every 10 (10%) reporting impacts to care, a majority of whom have had difficulties finding substitute medications (68%) and cited treatment delays (45%).

ACS CAN and partner organizations provided comments on the Medicare Drug Price Negotiation Program: Considerations for Selected Oncology Drugs.

ACS CAN strongly advocated for inclusion in the Inflation Reduction Act of both an annual cap on total Part D out-of-pocket costs and a mechanism that would allow an enrollee the option to pay the required cost-sharing in capped monthly installments because we know from research that hig

ACS and ACS CAN provided comments to the Centers for Medicare and Medicaid Services on the list of Part D drugs selected for the price negotiation program authorized under the Inflation Reduction Act (IRA).

Prescription Drug Affordability Resources:

Patient Assistance Programs

Prescription drug costs are a significant burden on cancer patients and survivors, sometimes even leading patients to miss or delay taking prescribed medications. The latest Survivor Views survey explores the role copay assistance programs can play in reducing this burden, and also addresses patient navigation and digital therapeutics.

A majority of cancer patients and survivors struggle to afford cancer care and over 80% have had to make financial sacrifices to cover their health care expenses. This survey also reveals ways that affordability concerns can negatively impact care and treatment, and explores issues related to prescription drug coverage and pain management options.

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.

This Survivor Views survey examined access to and affordability of cancer care. Survivors report insurance-related barriers to obtaining prescriptions, and lower-income respondents in particular have difficulty affording them.  24% of respondents have received a surprise medical bill, 60% of which were more than $500.

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).

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.

Medicaid Resources:

ACS CAN submitted comments opposing Tennessee's proposal to fund its Medicaid program through a block grant and implement a closed formulary.

ACS CAN comments supporting Medicaid expansion in Oklahoma, but opposing their proposal to rescind retroactive eligibility

An increasing number of states are seeking greater flexibility in administering their Medicaid programs. The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) give states the opportunity to test innovative or alternative approaches to providing health care coverage to their Medicaid populations through Section 1115 Research and Demonstration Waivers (otherwise known as "1115 waivers"). States must demonstrate that their waivers promote the objectives of the Medicaid and Children’s Health Insurance Programs (CHIP) and CMS must use general criteria to determine whether the objectives of the Medicaid/CHIP programs are met.

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