Access to Care
Access to treatments and services can critically affect the outcomes of people living with cancer. Delays caused by barriers like affording an insurance copay, being uninsured or finding a provider within one’s network can all postpone or prevent screening and treatment. Policies like the Affordable Care Act and various state mandates have lowered some economic hurdles with zero copays for some cancer screenings and other prevention measures. Resources in this category underscore these issues.
Access to Insurance
Access to care often hinges on what type of insurance coverage a person has, if any. These resources focus on that intersection.
Coverage and Cost
A person’s insurance coverage, or lack thereof, often dictates how much they will pay out of pocket, including premiums, copayments, deductibles and coinsurance. Coverage and cost of treatments and prescription drugs are where consumers are likely to face these issues. Resources in this category emphasize this relationship.
- American Society of Clinical Oncology – Addressing Financial Barriers to Patient Participation in Clinical Trials
- JAMA, June 2022, Barthold, Yueng et al., "Comparison of Screening Colonoscopy Rates After Positive Noninvasive Testing for Colorectal Cancer in States With and Without Cost-Sharing"
- Survivor Views: Cancer & Medical Debt February 2022 Survey Findings Summary, American Cancer Society-Cancer Action Network (ACS-CAN)
- JAMA, Dec. 2021, Fu et al. "Out of Pockets Costs Among Patients With a New Cancer DiagnosisEnrolled in High-Deductible Health Plans vs.Traditional Insurance"
- Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population- based cancer occurrence and outcomes. Cancer Statitstics for 2022 is the latest report.
- Annual Report to the Nation on the Status of Cancer: The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries provide annual information about cancer occurrence and trends in the United States.
- Out-of-Pocket Spending Limits are Crucial for Cancer Patients & Survivors
- Things to Know About the Cost of Your Cancer Treatment Help Paying for Prescription Drugs
Biomarkers and Precision Medicine
Rather than killing tumor cells like traditional chemotherapy treatments, new targeted cancer therapies act on specific cancer related molecules to block tumor cell growth. Some therapies, like chemotherapy, work through a general mechanism of action. When a precise mechanism of action is known, a treatment can be developed which ‘targets’ a particular tumor. Targeted therapies are part of a broader transformative treatment option referred to as precision, or personalized, medicine.
Precision medicine—which customizes a patient’s treatment based on factors like a person’s genomic profile and physical environment—includes testing for biomarkers. A biomarker is a biological molecule, or molecular marker, found in blood, bodily fluids and tissues. Biomarker testing identifies changes in a person’s genes or proteins, whether disease process is present or not and can identify the specific characteristics of the person's disease. Biomarker testing also provides doctors with specific information about which, if any, targeted therapies might be effective, Biomarker testing may reduce the number of adverse drug reactions a person experiences and some studies link testing to increased chances of survival.
How is Biomarker Testing Used?
Biomarkers are often used in clinical trials and can aid in drug discovery. Instead of relying on natural endpoints such as survival rates, biomarkers can be used as surrogates. One study looking at medicines approved between 2015-2019 in the United States and Europe found approximately 65% were associated with at least one biomarker. On the other hand, some research argues against the use of biomarkers for this purpose, citing that overdependence on surrogate endpoints may lead to unsafe or ineffective treatments.
||AZ HB 2144
||Would require health insurance coverage of biomarker testing when supported by scientific evidence. Enacted
CA SB 535
Provides for health insurance coverage of genetic testing for various cancer mutations, effective Jan. 1, 2022. Enacted
||CA SB 912
||Provides that biomarker testing shall be covered for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of a Medi-Cal beneficary's disease or condition only if the test is supported by medical and scientific evidence. Vetoed
||GA HR 998
||A resolution recognizing the benefits of biomarker testing as a necessary part of precision medicine; and for other purposes. Adopted.
||IL HB 1779
Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after Jan. 1, 2022, shall include coverage for biomarker testing. Enacted
||IL HR 138
||Declares March 2021 as Precision Medicine and Biomarker Testing Awareness Month in the State of Illinois. Enacted
|IA HR 6
A resolution designating the month of March, annually, as Precision Medicine and Biomarker Testing Awareness Month. Adopted
||LA SB 84
Requires insurance plans cover genetic and genomic testing including biomarker testing when medically indicated. Enacted
||LA SB 118
Makes amendments to SB 84: Clarifies testing must be covered when supported by the sources of evidence in the model bill. Passed House
||MA SB 808
Would remove prior authorization of biomarker testing when a person has metastatic stage 3 or 4 cancer. Introduced
||MN HF 4899
||Health plans required to provide coverage for biomarker testing. Introduced.
||NH HB 1290
||Would establish a task force on precision medicine and biomarker testing. Referred for interim study.
||NY SB 105
||Would require health insurance policies to cover comprehensive genetic screening and FDA approved biomarker testing for ovarian and prostate cancers. Introduced
||OH HB 608
||Require health plan and Medicaid coverage of biomarker testing. Referred to health committee.
RI HB 7587
RI SB 2201
|Would requires health insurers, nonprofit hospital service corporations, nonprofit medical service corporations and health maintenance organizations that issue policies that provide coverage for biomarker testing on or after 1/1/23. Enacted.
||WA HB 1689
||Would exempt biomarker testing from prior authorization for patients with late stage cancer. Enacted.
Passed in 2016, the bipartisan 21st Century Cures Act includes the Cancer Moonshot—research funded over seven years meant to boost progress in cancer care—and the Precision Medicine Initiative, a national data collection effort. An essential component of the act is developing a Human Tumor Atlas Network that will aid in identifying novel predictive biomarkers. Under the act, a three-stage submission process was developed to qualify biomarkers for use. Now, as the project concludes its fifth year, over $1 billion in funding has supported 240 research projects involving more than 70 organizations.
- With the Centers for Disease Control and Prevention's (CDC) Data Explorer, you can search data on six cancer types (lung, female breast, prostate, colorectal, kidney, and melanoma) from 27 cancer registries with new population-based geographies. Population-based geographies allow you to look at data changes related to environmental, community, and health, especially in areas where there are high or low populations in counties. These local data can help guide public health decisions regarding community-based actions and cancer screening services. Subcounty-level cancer data are also available.
- The Centers for Disease Control and Prevention (CDC) has a wide range of cancer-related resources, including U.S. cancer statistics by state, resources for survivors and caregivers, and more.
- CDC’s Division of Cancer Prevention and Control provides a wide variety of data, information and resources dedicated to cancer prevention for everyone.
NCSL provides links to third-party websites for information purposes only. Providing these links does not indicate NCSL's support or endorsement of any third-party site material. Use of brand or manufacturer names also are informational only. NCSL is not responsible for the opinions or facts on such sites.
NCSL would like to acknowledge Amgen for supporting this update.