Decision by the Centers for Medicare and Medicaid Services lowers barriers to healthcare access for individuals with Medicare
CENTER VALLEY, Pa. (Nov. 14, 2022) - Olympus, a global technology leader in designing and delivering innovative solutions for medical and surgical procedures, today applauded the decision by the Centers for Medicare and Medicaid Services (CMS) to eliminate cost sharing for Medicare beneficiaries who have a colonoscopy in follow-up to a positive at-home colorectal cancer test. Prior to this policy change by CMS, patients whose at-home screen resulted in concerning results were faced with co-pay costs associated with follow-up colonoscopy; these costs are now eliminated for the covered patient. Olympus also supports the decision for Medicare to cover colonoscopies beginning at age 45, which is in line with the new age recommendation from the United States Preventive Services Task Force (USPSTF).1
"These rule changes represent a significant step toward improving colorectal cancer care and expanding access to preventive screenings," said Paul Skodny, executive director, Global Health Economics & Market Access at Olympus Corporation of America. "The American Society for Gastrointestinal Endoscopy (ASGE) considers colonoscopy the gold standard for screening2, but the procedure may not be readily available to everyone. That's why it's so important to support colon cancer screening and detection by eliminating cost sharing, such as co-pays, when an at-home test reveals the need for a follow-up colonoscopy."
A colonoscopy can help prevent colorectal cancer (CRC) by finding and removing polyps that can develop into cancer.3
CMS is expanding the regulatory definition of colorectal cancer screening tests to include a complete colorectal cancer screening in which a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based colorectal cancer screening test returns a positive result.
The USPSTF last year lowered the recommended screening age for those at average risk for colorectal cancer from 50 to 45. The CMS rule change brings Medicare coverage in line with USPSTF recommendations and makes coverage consistent with Medicaid and most private coverage.
The American Cancer Society estimates that more than 150,000 cases of CRC will be diagnosed in 2022 accompanied by more than 52,500 deaths. The CRC death rate has steadily declined from 29 per 100,000 cases in 1970 to just under 13 per 100,000 cases in 2019, a roughly 56% drop. The American Cancer Society attributes that trend primarily to earlier detection through screening and improvements in treatment.4
While incidence of CRC in adults ages 50 and older decreased by about 2% annually between 2014 and 2018, they increased by 1.5% per year in younger people, according to the American Cancer Society. When caught in its earliest stages, colorectal cancer has a roughly 90% five-year survival rate.2
"Given the trend of increased incidence of colorectal cancer among a younger patient population, it's more important than ever to make sure cost doesn't serve as a disincentive for preventive screening," says Taichi Nakamura, , M.D., Ph.D., Olympus Corp., Medical Scientific Affairs, GI/ET Global Medical Lead. "Data already shows that about half of eligible adults ages 50 to 54 are not up to date with CRC screening.5 Olympus remains committed to improving patient outcomes by raising awareness around colorectal cancer, as well as the benefits of preventive screenings generally."
The New England Journal of Medicine recently published study results from the Northern-European Initiative on Colorectal Cancer (NordICC) trial.6 The accompanying media coverage suggested that the benefits of colonoscopies may have been overestimated. However, physicians reacting to the media coverage pointed out that the study results were misinterpreted.
The study included 84,585 men and women from Norway, Sweden, Poland and the Netherlands between the ages of 55-64. But of the roughly 28,000 people invited to undergo a screening colonoscopy, only about 42% had one. The study found that those who had a colonoscopy saw a reduction in CRC incidence and death by 31% and 50%, respectively. Olympus supports the positions of gastroenterology societies and stands behind the conclusion of the ASGE that having a colonoscopy performed according to clinical guidelines remains the recommended screening method for CRC.
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- U.S. Preventive Services Task Force, "Final Recommendation Statement, Colorectal Cancer: Screening." May 2021
- American Society for Gastrointestinal Endoscopy, "Value of Colonoscopy."
- American Cancer Society, "Cancer A-Z, Can Colorectal Polyps and Cancer be Found Early?"
- American Cancer Society, "Cancer Facts & Figures 2022."
- American Cancer Society, "Colorectal Cancer Facts & Figures 2020-2022."
- Kaminski MF, Bretthauer M, Zauber AG, Kuipers EJ, Adami HO, van Ballegooijen M, et al. "The NordICC Study: Rationale and design of a randomized trial on colonoscopy screening for colorectal cancer."