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Susan G. Komen Florida Lobby Day November 6, 2019
Join Susan G. Komen, breast cancer patients, warriors, co-survivors, physicians, and researchers as they advocate for quality breast health care and funding for research and breast screenings in Florida.
Susan G. Komen Florida Legislative Priorities
Stage Four Advanced, Metastatic Cancer Step Therapy
Step therapy also referred to as “fail first”, requires a patient to first try a preferred (often generic alternative) drug prior to receiving coverage for the originally prescribed drug. Step therapy is a method of utilization management health plans employ to control costs by beginning treatment with more cost-effective drug therapy and then progressing to the newer, more costly treatments only if necessary. Legislation can prohibit health plan companies from requiring enrollees to follow step therapy protocols for stage four advanced metastatic cancer. This legislation does not prohibit the use of generics for treatments and only serves to ensure that the patient has access to most appropriate treatment for their condition.
Stage Four Advanced Metastatic Cancer Step Therapy
- Currently, in the U.S. more than 154,000 people are living with metastatic breast cancer. Metastatic breast cancer is an advanced stage of breast cancer where tumor cells have spread to other parts of the body. It is estimated that nearly all of the more than 42,000 breast cancer deaths expected this year will be a result of metastasis.
- Although metastatic breast cancer cannot be cured, it can be treated. Treatments are highly personalized and must be based on decisions made by the patient and their healthcare providers, as they are most capable in determining the appropriate treatment for patients. Unfortunately, most step therapy protocols rely on generalized information regarding patients and their treatments as opposed to considering unique patient experiences, and responses to different treatments.
- Due to the spread of cancer to other parts of the body, a majority of patients suffer from a number of associated conditions including comorbidities, symptoms and/or side effects (i.e. weakening of bone, anemia, central nervous system issues, pain, etc).
Effective and Appropriate Coverage
- Physicians should not be forced to make decisions based on protocols that rely on generalized patient information as opposed to making decisions based on the unique needs of each patient.
- Patients and physicians should have the opportunity to choose the best therapy without the burden of overly restrictive cost-containment policies.
Diagnostic Imaging Coverage
Traditional screening mammography is an x-ray examination of the breast of an asymptomatic woman. Once signs or symptoms of breast disease have been found, diagnostic imaging (diagnostic mammography, ultrasound, breast MRI, etc) is recommended. In addition, diagnostic imaging may be recommended for women who have a prior history of breast cancer.
- Diagnostic mammograms are performed in the same way and with the same equipment as traditional screening mammograms, usually requiring additional views and under the immediate supervision of the interpreting physician.
- Required follow-up diagnostic imaging due to an abnormal mammogram is critical in the prevention process. An estimated 15 percent of screening mammograms require follow-up diagnostic imaging.
- From an early detection perspective, a screening mammogram would not be considered successful if follow-up diagnostic imaging were not preformed to identify the abnormality or possible cancer.
Fair and Equal Coverage of Mammography
- Patients may be required to pay higher co-pays, co-insurance, and other cost-sharing mechanisms when obtaining diagnostic imaging services.
- If women are unable to afford the out-of-pocket costs, many might delay or forego follow-up screenings, leading to later diagnoses. This delay can mean that women will not seek care until the cancer has spread beyond the breast making it much deadlier and much more costly to treat.
- These will reduce out-of-pocket costs for diagnostic imaging would improve access and allow for more timely diagnosis and treatment of breast cancer.
The Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP), also known as the Mary Brogan Program, is a federal-state partnership between the Centers for Disease Control and Prevention (CDC) and Florida Health, providing potentially life-saving breast cancer screening and diagnostic services to low-income, uninsured and underinsured women who do not qualify for Medicaid.
Screening and Early Detection
- An estimated 19,130 Florida women will be diagnosed with breast cancer and 3,000 will die from this disease in 2019.
- While the Affordable Care Act (ACA) has provided greater access to mammography for many low-income women, with the continued uncertainty and changes to the ACA, it is imperative that women continue to have access to early detection services.
- In Florida, more than 1 million uninsured women will continue to struggle without access to affordable health coverage.
- Without access to breast cancer early detection programs, many uninsured women are forced to delay or forego screenings, which can lead to late-stage breast cancer diagnoses.
- This delay can mean that a woman won’t seek care until the cancer has spread beyond the breast, making it up to five times more expensive and much harder to successfully treat.
The Mary Brogan Program
- The Mary Brogan Program provided more than 83,860 services to women and diagnosed 844 breast cancers from July 2014 to June 2017.
- At current funding levels, the program serves less than 8.1 percent of the estimated number of Florida’s eligible women.
- The availability of the Mary Brogan Program impacts every taxpayer, as the uninsured will eventually show up at our states’ hospitals with late-stage diagnoses, putting an even greater strain on the health system and state budgets.
- Ensuring adequate funding is key to ensuring that low-income, uninsured and underinsured women continue to have access to vital screening services, providing newly insured women access to health education, and patient navigation services, as well as enabling proper monitoring of state and local breast cancer patterns and trends.
Susan G. Komen Advocacy Priorities
Every two years, Komen identifies the advocacy issues where Komen’s voice could provide the greatest potential impact on achieving our Bold Goal. A broad-based, intensive vetting and selection process includes feedback from Affiliates, representatives from the African-American Health Equity Initiative (AAHEI), metastatic breast cancer community, Advocates in Science (AIS), Komen Scholars and subject matter experts. The following issues form the basis for Komen’s state and federal public policy and advocacy work through 2020.
Komen’s 2019 – 2020 Public Policy & Advocacy Priorities:
- Ensure access to affordable, high-quality health care
- Protect access to affordable, high-quality health care for all patients
- Support Medicaid expansion and expanded eligibility for Medicaid’s Breast and Cervical Cancer Treatment Program (BCCTP)
- Ensure continued access to Medicaid coverage without burdensome restrictions
- Advance breast cancer research
- Expand federal funding for all biomedical research, especially breast cancer research conducted at the National Institutes of Health (NIH) and at the Department of Defense (DOD)
- Support state funding for breast cancer research programs conducted through state institutions
- Support increased education, utilization of and access to clinical trials for all patient populations
- Increase coverage and access to breast cancer screening and diagnostic services
- Support federal and state funding for the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
- Support policies to modernize NBCCEDP state programs to expand eligibility and provide breast cancer screening and diagnostic services for additional populations
- Reduce or eliminate out-of-pocket costs for diagnostic imaging
- Reduce insurance barriers to treatment
- Protect patient preference and enhance coverage, including policies that would require oral parity, preclude specialty tiers, prevent step therapy protocols, prevent non-medical switching and limit patients’ out-of-pocket costs
Komen Florida Advocacy in the News
Become an Advocate
The Susan G. Komen Advocacy Alliance (KAA) is the non-partisan voice for over 2.5 million breast cancer survivors and the people who love them. Our mission is to translate the Komen promise to end breast cancer forever into action at all levels of government to discover and deliver the cures.