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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:

Having affordable and comprehensive health insurance coverage is a key determinant for surviving cancer.

Having affordable and comprehensive health insurance coverage is a key determinant for surviving cancer.

Having affordable and comprehensive health insurance coverage is a key determinant for surviving cancer.

Our latest survey finds that about half of cancer patients and survivors (49%) have incurred medical debt to pay for their cancer care and another 13% expect to incur medical debt as they begin or continue their treatment. Nearly all of those (98%) had health care coverage at the time they accumulated medical debt. This survey also explores the broad health and financial implications of medical debt, how medical debt deepens inequites, and the alarming rate of cancer related medical debt among younger respondents with early diagnoses.

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. 

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%).

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.

Private Health Insurance Resources:

ACS CAN submitted comments on September 16, 2020, to CMS regarding Georgia's 1332 waiver application.

Last year, the Administrative finalized a regulation that expands access to short-term, limited-duration insurance products. Short-term plans were originally intended to bridge gaps in comprehensive coverage – for instance, when an individual was between jobs and temporarily without access to an employer plan.

ACS CAN Comments on Interstate Sale of Insurance

ACS CAN submitted comments regarding the 2020 Proposed Notice of Benefit & Payment Parameters for the individual insurance market.

ACS CAN submitted comments on the proposed 2019 CMS Program Integrity Rule.

ACS CAN submitted comments regarding a proposed rule to change Health Reimbursement Arrangements (HRAs) and other account-based group health plans.

On March 6, 2018, ACS CAN filed comments on the proposed rule implementing changes to the Employee Retiree Income Security Act’s (ERISA’s) definition of “employer” for purposes of determining when employers may join together to form an Association Health Plan (AHP).

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

ACS CAN Comments on Short-Term Policies

Medicare Resources:

The incidence of cancer increases with age and thus the Medicare program is vitally important to millions of Americans who are undergoing active cancer treatment, are cancer survivors or who have not yet developed cancer.

ACS CAN Comments to Seema Verma, Administrator, Centers for Medicare and Medicaid Services

ACS CAN submitted comments on the Medicare Part C and D Rule.

Approximately 1.7 million new cancer cases are expected to be diagnosed in 2018. Age is one of the most important risk factors for cancer, with one half of cancer cases occurring in people over the age of 65.

ACS CAN filed extensive comments expressing deep concern with the proposed Medicare Part B Drug Payment Model and noting that in its proposed form the Part B Drug Model Model failed to protect cancer patients' access to life-saving medications.

This analysis examines two issues of particular interest to the American Cancer Society Cancer Action Network (ACS CAN) and its members: the extent of coverage and cost-sharing for cancer drugs, and whether information on the coverage of cancer drugs can be readily obtained, compared, and understood by patients.

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Medicaid Resources:

ACS CAN strongly opposes any attempt by the federal government or states to condition Medicaid coverage on work or community engagement.

ACS CAN opposes per capita caps, block grants, and other capped funding structures for the Medicaid program, as they endanger access to care.

Cancer patients and survivors must balance reducing their health care costs with ensuring they have comprehensive coverage of services, treatments, and care providers.

ACS CAN submitted comments strongly supporting several policy changes that will make it easier to apply for, enroll in, and maintain enrollment in Medicaid and CHIP.

ACS CAN submitted comments regarding Tennessee's latest application to renew their 1115 waiver.

ACS CAN submitted comments to the Centers for Medicare & Medicaid Services regarding its 2022 Request for Information on Access to Coverage and Care in Medicaid & CHIP. Our comments address suggested improvements in Medicaid enrollment and eligibility determination, transitions of coverage, national standards for access to care, and the eventual end of the public health emergency and continuous coverage provisions.

ACS CAN submitted comments in support of the renewal of Oregon's 1115 Medicaid waiver, including the state's proposal of continuous coverage provisions for children and adults. However, ACS CAN strongly objects to the state's proposal to limit Medicaid coverage of drugs approved through the accelerated approval process, and urges CMS to reject this part of the waiver request.

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