Episode #63: Despite ACA Mandate Most Patients Pay for Bowel Prep | Michael Weinstein & Eric Shah | University of Michigan

Gastro Broadcast

Dr. Michael Weinstein interviews Dr. Eric Shah, director of the Michigan Medicine GI Physiology Laboratories about a study showing that despite a federal law that says bowel preparations needed for colonoscopy should be covered by insurance, many patients are still paying out of pocket. The study, from the University of Michigan Health, analyzed nearly 2.6 million insurance claims from both commercial insurance plans and Medicare Part D, and looked at how many patients paid for bowel prep medications needed for colonoscopy. The Affordable Care Act (ACA) requires that certain preventative services, including colorectal cancer screening, must be covered by insurance plans without cost-sharing for patients. Unfortunately, prescription bowel prep for screening colonoscopy is still subject to cost sharing for most patients, running contrary to the ACA's mandate. When considering that nearly half of patients are cost-shifted toward the use of non-FDA approved over-the-counter regimens, the data suggest that only 17 percent of patients pay zero for their bowel preparation for screening colonoscopy. Of the prescription claims analyzed, only 36 percent had no out-of-pocket costs. Additionally, high-volume preps were more likely to be free compared to new, low-volume or tablet preparations. However, when patients did pay, high-volume preps cost a median of $10, while low-volume preps cost $60. For Medicare Part D, only 25 percent of high-volume preps were free, compared to 10 percent for low-volume preps. Join Dr. Weinstein and Dr. Eric Shah as they discuss how these co-pays for bowel prep can impact patients and what private practice gastroenterologists can do to educate their communities and to engage in advocacy so that co-pays do not present a barrier to colorectal cancer screening. Produced by Andrew Sousa and Hayden Margolis for Steadfast Collaborative, LLC Mixed and mastered by Hayden Margolis Gastro Broadcast, Episode 63