When a massive clinical trial about lung cancer screening shows a benefit to current and former smokers, why can it take so long to become accessible for most people?
A draft recommendation by a federal task force in favor of using low-dose CT scans to screen past and current heavy smokers for lung cancer provides insight about the time lag.
The recommendation says that low-dose spiral CT lung cancer screening is only appropriate for those who:
• Are 55 to 80 years old
• Have a 30-pack-year history of smoking (which translates to 1 pack of cigarettes a day for 30 years, 2 packs a day for 15 years, etc.)
• Smoke or have quit smoking within the past 15 years
companies expected to cover CT lung cancer screening for smokers
The task force carefully sorts the pros and cons of a preventive procedure before recommending for or against. Its rulings are highly influential, so both governmental and private health insurers tend to wait for its recommendations before deciding whether to pay for a procedure, Munden says.
The task force's recommended B rating for the procedure, subject to a comment period that ends Aug. 26, is significant. Right now, 95% of the people who want screening have to pay for it out-of-pocket, because only two health insurance companies cover it. Medicare and Medicaid don't reimburse for it, but the task force's recommendation is expected to change that.
"The implications are huge," says Therese Bevers, M.D., medical director of MD Anderson's Cancer Prevention Center. "Health plans, under the Affordable Care Act, are required to cover any screening or service given an A or B rating by the U.S. Preventive Services Task Force. They're not only required to cover it, but to cover it without any co-payment or deductible so the patient is able to get this at no out-of-pocket cost."