The one-house budget proposals revealed a clear divide in the Legislature’s approach to the equitable treatment of disease. The New York State Senate flatly rejected the governor’s proposal to roll back Medicaid coverage criteria for biomarker testing, heeding the calls of cancer survivors, patient advocates and public health organizations, like the American Cancer Society Cancer Action Network (ACS CAN). The Assembly took a more mixed approach accepting parts of the Governor’s proposed language while rejecting others.
The Assembly budget proposes to keep FDA-approved/cleared tests, labeled indications for FDA-approved drugs and Medicare national and local coverage determinations as evidence criteria for determining coverage, while cutting nationally recognized clinical practice guidelines and peer reviewed studies as evidence criteria.
While ACS CAN does not see a concern over the elimination of peer reviewed studies , it is deeply concerned over the elimination of nationally-recognized clinical practice guidelines as evidence criteria.
Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care. Evidence-based clinical practice guidelines are developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure along with a conflict-of-interest policy.
Clinical practice guidelines are the most frequently consulted resource in deciding whether to recommend or order biomarker testing, cited by 91% of oncology providers in a recent survey.
In response, Michael Davoli, who serves as the senior government relations director for ACS CAN in New York, said the following:
“Three years ago, New York State lawmakers came together and found a bipartisan solution to New Yorkers’ inequitable access to biomarker testing and the precision medicine treatments it unlocks. They bridged divides to deliver for patients and put New York at the forefront of the fight for health care affordability. Unfortunately, with their one house budgets, the Legislature produced divergent priorities, and only one chamber, the Senate, rejected the premise that our state can and our residents should weather a setback in health equity and affordability.
“We thank the Senate and its leadership for opting to preserve Medicaid enrollees’ access to biomarker testing and keep coverage criteria consistent for some of our most vulnerable residents who, following H.R. 1, are already seeing new, daunting barriers to care crop up. We urge the Assembly and the Governor to weigh the full impact of restricting access to biomarker testing: the measurable consequences for health outcomes among Medicaid enrollees and the immeasurable toll on patients facing a life-altering diagnosis. And we hope that both chambers and the Governor preserve Medicaid access to biomarker testing in the final budget, including nationally recognized clinical practice guidelines on the list of evidence criteria using in making coverage determinations.”
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About ACS CAN
The American Cancer Society Cancer Action Network (ACS CAN) makes cancer a top priority for policymakers at every level of government. ACS CAN empowers volunteers across the country to make their voices heard to influence evidence-based public policy change that improves the lives of people with cancer and their families. We believe everyone should have a fair and just opportunity to prevent, find, treat, and survive cancer. Since 2001, as the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN has successfully advocated for billions of dollars in cancer research funding, expanded access to quality affordable health care, and advanced proven tobacco control measures. We’re more determined than ever to stand together with our volunteers to end cancer as we know it, for everyone. Join the fight by visiting www.fightcancer.org.
