Lung cancer is the leading cancer killer, yet coverage of screenings for individuals at high risk for lung cancer varies across state Medicaid programs, according to a new report released today by the American Lung Association. To ensure those eligible can access lifesaving lung cancer screenings, the American Lung Association and The University of TexasMD Anderson Cancer Center have partnered on educational initiatives to improve coverage for recommended low-dose computed tomography (CT) lung cancer screenings in state Medicaid programs.
According to the report, “Lung Cancer Screening Coverage in State Medicaid Programs,” 31 Medicaid fee-for-service programs cover lung cancer screening, 12 programs do not provide coverage, and 7 states did not have information available on their coverage policy. The analysis also found that Medicaid programs varied in the eligibility criteria they used for screening as well as whether they required prior authorization.
“Lung cancer is called the quiet killer, as it has few early symptoms and is oftentimes caught too late,” said American Lung Association President and CEO Harold Wimmer. “Coverage for screening with low-dose CT is critical, and this analysis will advance our work to ensure those eligible with state Medicaid coverage have access to this lifesaving screening.”
“Our mission at MD Anderson is to end cancer, and we know that the best way to do this is through cancer prevention and early detection,” said Peter WT Pisters, M.D., president of MD Anderson. “Evidence-based screening is vital for those at high risk to ensure that lung cancer, when it’s present, is detected as early as possible. These actions must also complement our efforts in tobacco prevention and cessation, through which we could eliminate the vast majority of lung cancers.”
Lung cancer screenings can dramatically reduce the mortality from lung cancer in those considered at high risk, and have been recommended by the U.S. Preventive Services Task Force (USPSTF). While screening is covered as a preventive service at no cost by most private health insurance as well as by Medicare, state Medicaid programs are not required to cover the screening or can offer coverage with significant barriers. Coverage for those covered by Medicaid is especially important as 26.3 percent of Medicaid beneficiaries are current smokers—a key factor in being high risk for lung cancer.
The USPSTF defines those at high risk of lung cancer as individuals age 55-80, who have a 30 pack-year history of smoking and currently smoke or have quit smoking within the past 15 years. Eight million Americans are considered at high risk and eligible for this annual screening, and if all those eligible were screened, an estimated 25,000 lives would be saved.
The report also found that state Medicaid programs differ with the eligibility criteria that they use for screening, with 16 states following the USPSTF or very similar Medicare criteria, and 15 states adopting other criteria.
In addition to the analysis released today, the Lung Association and MD Anderson also have released a new toolkit with resources to educate state-level decisionmakers and build awareness among healthcare professionals about gaps in Medicaid coverage of lung cancer screening.
Feature Courtesy of the University of Texas MD Anderson Cancer Center