More than half a dozen major private health insurance companies have agreed to pay for navigators to guide cancer patients and their families through the confusing series of appointments and post-diagnosis drug treatments.
The expansion of the Cancer Navigator program, part of President Joe Biden's ambitious cancer moonshot, is one of a handful of health initiatives announced this week in conjunction with the president's State of the Union address.
Advocates say navigators can help guide patients and their families through medical appointments and the choices they face after a cancer diagnosis. Government officials cited research showing that navigators can help reduce wait times from diagnosis to treatment. When working with a navigator, patients are more likely to complete treatment.
Starting this year, the Centers for Medicare and Medicaid Services announced it will cover navigation services for older Americans enrolled in Medicare. The agency also established billing codes for hospitals and physicians to bill health insurance companies for navigator services.
The Biden administration agrees to cover Navigator services with seven major private health insurance companies: Aetna, Blue Cross Blue Shield of Minnesota, Elevance Health, Health Alliance Plans, Humana, Priority Health, and Select Health. It was announced that.
In addition, 40 cancer treatment centers and clinics will expand navigator services to patients. The list includes renowned cancer treatment centers such as Boston's Dana-Farber Cancer Institute, Duke Cancer Institute, Northwell Health, and Mayo Clinic.
“This is about making sure more and more Americans have access when they need it,” Arati Prabhakar, director of the White House Office of Science and Technology Policy, told USA TODAY. “The companies we contract with to provide insurance for these services…impact 150 million Americans.”
Patient advocates, who are familiar with the challenges of managing cancer diagnoses in the nation's fragmented health care system, said navigators play an important role.
Kathy Giusti, a two-time cancer survivor and co-founder of the Multiple Myeloma Research Foundation, often speaks about the challenges patients face after being diagnosed with cancer. She describes the U.S. health care system as “vast, fragmented and difficult,” and worries that patients are missing out on the best treatments science has to offer.
He said Navigator coverage through Medicare and broader rollout with private insurance companies will help patients.
“Trained navigators will reduce the burden on patients and their caregivers,” Giusti said. Her book, From Deadly to Fearless: Her 12 Steps to Beating Cancer in a Broken Medical System, describes her cancer journey and offers tips for others. There is. “This is a short-term positive solution to a long-term problem.”
Navigators can advocate and educate patients on how to better coordinate their care. Specially trained individuals can also connect patients and their families with social services to address food, housing, and transportation needs.
Prabhakar said people face so many decisions and challenges after being diagnosed with cancer. They must make plans and arrange transportation. Some patients seek access to new drugs and treatments being investigated in clinical trials.
“The moment you hear a doctor say the 'C' word, the world starts spinning apart,” said Prabhakar, Biden's chief of staff for science and technology. “Having someone around to help brings some calm during difficult times.”
Cancer Moonshot, launched during President Barack Obama's term, was part of the 21st Century Cures Act passed in 2016. Mr. Biden reinvigorated this effort in 2022, setting a goal of reducing the age-adjusted death rate from cancer by 50% within 25 years and supporting patients. People living with cancer and their caregivers.
The American Cancer Society predicts that 611,720 people will die from cancer this year, a slight increase from estimates from a year ago. Cancer mortality rates decreased by 33% between 1991 and 2021, largely due to lower smoking rates, earlier detection, and improved treatments.
In Thursday's State of the Union address, Biden touted a plan to more than double the number of drugs for which Medicare can negotiate prices. His goal is 20 to 50 drugs per year.
A 2022 federal law gives CMS the authority to negotiate lower Medicare drug prices for the first time. The Biden administration has named the first 10 diabetes, heart disease and cancer drugs that Medicare will negotiate, but price changes for those drugs won't take effect until 2026. The program plans to increase the number of drugs under negotiation to 15 in 2027, 2028, and 2020. After that, you will be given the drug every year.
Earlier this week, administration officials announced that Biden would ask Congress to cap out-of-pocket costs for Medicare patients at $2 for “high-cost generic drugs.”
The U.S. Department of Health and Human Services plans to publish a list of proposed $2 generic drugs, including statins to treat high cholesterol and beta-blockers for high blood pressure.
Pharmaceutical companies and industry allies have filed nine lawsuits challenging various aspects of the anti-inflation law. These legal challenges have not slowed the administration's efforts to negotiate cost reductions.
The American Pharmaceutical Research Association, a trade group representing drug companies, said price negotiations threaten drug innovation.
PhRMA Chairman and CEO Stephen J. Uble said in a statement that the Inflation Control Act is “a life-saving, life-saving project, much like the very research needed to get the president's cancer moonshot back on track.” “It stifles research and creates barriers to patient access.”
