Susan G. Komen® Advocates to Remove Cost Barriers
Susan G. Komen North & West Texas has worked for the last 29 years to ensure Texas women have access to life-saving breast cancer screening, diagnostics, and treatments services, through fundraising, grants and educational services. Unfortunately, the need is always greater than the funding. Knowing they had to do more to meet the needs of the community, the Komen Affiliates looked to advocacy to help meet the growing need.
Komen works closely with health care providers and those impacted by breast cancer in their local communities to identify barriers to screening and treatment, and the potential policy solutions to address the complex issues.
Having identified several issues to target, Komen worked directly with Representative Diego Bernal (TX-123) to determine how best to address the needs of women throughout Texas through policy.
During the 2019 Texas Legislative Session, Komen partnered with Representative Bernal to sponsor HB 170, which eliminates the patient’s out-of-pocket costs for diagnostic mammograms.
Realizing that while traditional screening mammography is typically covered at no cost to patients, after a lump or other signs or symptoms of disease have been found, the diagnostic imaging required for Texas patients with private insurance varied from $336 to $836, depending on their insurance company. HB 170 eliminates this disparity by requiring plans to fully cover diagnostic mammography with no cost sharing to the patient. Governor Greg Abbot signed the bill into law on June 15, 2019.
“Screening mammograms are now fully covered through Medicare, Medicaid and most private insurance plans. However, patients were generally required to pay co-pays, co-insurance and other cost sharing mechanisms for diagnostic mammography. The enactment of HB 170 will allow more women in Texas to receive the diagnostic imaging required to identify whether or not they have breast cancer, leading to saved lives through earlier detection and timelier treatment.” states Mary Frances Hoover, Executive Director of Susan G. Komen North & West Texas.
Komen also supported HB 1584 by Representative Senfronia Thompson (TX-141), which eliminated step therapy protocols for metastatic, stage four cancer patients. Step therapy, also referred to as “fail first”, is a utilization management tool that requires a patient to first try a preferred (often generic alternative) drug prior to receiving coverage for the originally prescribed drug. HB 1584 eliminates step therapy for cancer treatments and associated conditions for metastatic, advanced stage-four cancer patients. Texas became one of only a handful of states to enact this legislation. Hoover stated, “Patients and physicians should have the opportunity to choose the best treatments and therapies without the burden of overly restrictive cost containment policies”. Both laws will become effective on September 1, 2019.
“With the passage of these two bills, women and men facing breast cancer will have access to the diagnostic services and treatments they need to fight this terrible disease,” Hoover stated. “It’s a great example of how Komen is fighting breast cancer at all levels – advocating for statewide legislative, our community grants program that provides free breast services like mammograms, and the research that will eventually bring us closer to finding the cures to this terrible disease.”