Some patients pay out of pocket for colonoscopy prep, according to a recent study, and many leaders are concerned about how that could affect screening volumes.
Gastroenterologist Eric Shah, MD, at Ann Arbor-based University of Michigan led the study, which found that only 17% of patients pay nothing for their bowel preparation for screening colonoscopy and that almost half of patients are cost-shifted toward the use of non-FDA-approved over-the-counter regimens.
Dr. Shah told Becker's the study identified a particular problem — a loophole where prescription drugs are tied to screening costs, and Medicare patients end up paying more.
Of the prescription claims analyzed, only 36% had no out-of-pocket costs. For Medicare Part D, only 25% of high-volume preps were free.
This loophole is an added barrier to getting patients screened for colon cancer, a real concern amid rising colon cancer diagnoses, particularly among patients under 50.
"If patients have to pay out of pocket for the prep, it could lead them to delay screening, especially given the current economy," Dr. Shah said. "If someone puts off screening because of $19, that’s a real problem. We need to reduce those barriers."
A big issue in getting patients screened is that bowel prep ends up being a huge barrier, Dr. Shah told Becker's, particularly with high-volume prep options. But for many low-volume prep options, insurance barriers wind up preventing patients from being covered.
"The challenge is that some patients don’t show up because the prep remains a barrier," he said. "These low-volume preps have been developed, but prescription drug cost barriers prevent their wider use. Screening tests are covered by insurance, but bowel prep is considered a prescription drug, so patients may face out-of-pocket expenses for whatever prep the insurance mandates."
And while some drug companies offer a copay card to lower the cost, it still can be expensive, he added.
"It all comes down to whether the copay system is working," he said. "Providers often prescribe the higher-volume preps, which are cheaper for insurance, but is this process affecting cancer screening rates? That’s what we should be focusing on — getting screening rates higher, however it's done."
A solution could be coverage of bowel prep without a cost share as part of colon cancer screening, he said. "If patients choose colon cancer screening, the prep should be included."
This would likely take legislative action because prescription drugs fall under a different part of the health insurance plan, managed by pharmacy benefits managers, while the screening test falls under medical benefits.
"The easiest solution might be for CMS to clarify that bowel prep must be covered, which would prompt insurance carriers to comply," he said. "But there will still be challenges."