Coverage for evidence-based cancer survivorship care services.
Publication/Presentation Date
2-17-2024
Abstract
PURPOSE: The American Society of Clinical Oncology Cancer Survivorship Committee established a task force to determine which survivorship care services were being denied by public and private payers for coverage and reimbursement.
METHODS: A quantitative survey instrument was developed to determine the clinical practice-reported rates of coverage denials for evidence-based cancer survivorship care services. Additionally, qualitative interviews were conducted to understand whether coverage denials were based on payer policies, cost-sharing, or prior authorization.
RESULTS: Of 122 respondents from 50 states, respondents reported that coverage denials were common ("always," "most of the time," or "some of the time") for maintenance therapies, screening for new primary cancers or cancer recurrence. Respondents reported that denials in coverage for maintenance therapies were highest for immunotherapy (41.74%) and maintenance chemotherapy (40.17%). Coverage denials for new primary cancer screenings were highest for Hodgkin lymphoma survivors needing a PET/CT scan (49.04%) and breast cancer survivors at a high risk of recurrence who needed an MRI (63.46%), respectively. More than half of survey respondents reported denials for symptom management and supportive care services. Fertility services, dental services when indicated, and mental health services were denied "always" or "most of the time" 23.1%, 22.5%, and 12.8%, respectively. Respondents reported they often had a process in place to automatically appeal denials for evidence-based services. The denial process, however, resulted in greater stress for the patient and provider.
CONCLUSION: Our study demonstrates that additional advocacy with payers is needed to ensure that reimbursement policies are consistent with evidence-based survivorship care services.
Volume
32
Issue
3
First Page
165
Last Page
165
ISSN
1433-7339
Published In/Presented At
Blaes, A. H., Abu-Khalaf, M. M., Bender, C. M., Dent, S. F., Fung, C., Smith, S. K., Watson, S., Katta, S., Merrill, J. K., & Hudson, S. V. (2024). Coverage for evidence-based cancer survivorship care services. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 32(3), 165. https://doi.org/10.1007/s00520-024-08359-9
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
38368466
Department(s)
Administration and Leadership
Document Type
Article