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States Must Do More to Ensure People at High Risk Can Be Screened for Lung Cancer

Lung cancer is the leading cause of cancer-related deaths, yet coverage of screenings for individuals at high risk for lung cancer varies across state Medicaid programs, according to a new report released by the American Lung Association. To ensure those eligible can access lifesaving lung cancer screenings, the American Lung Association and The University of Texas MD Anderson Cancer Center have partnered on educational initiatives to improve coverage for recommended low-dose 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 eight 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,” says 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,” says Peter WT Pisters, MD, 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 US 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% 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 aged 55 to 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 in 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, the Lung Association and MD Anderson have also released a new toolkit with resources to educate state-level decisionmakers and build awareness among health care professionals about gaps in Medicaid coverage of lung cancer screening.

The partnership is supported by MD Anderson’s EndTobacco program, an initiative of the cancer prevention and control platform working to eliminate the substantial burdens of tobacco use. The effort is the result of extensive collaboration between the platform and the Lung Cancer Moon Shot, which seeks to develop innovative screening and treatment approaches to save lives from lung cancer. All are part of MD Anderson’s Moon Shots Program, a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients’ lives.

— Source: American Lung Association