Current National Health Insurance Coverage Policies for Breast and Ovarian Cancer Prophylactic Surgery
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Background: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures.
Methods: A confidential detailed cross-sectional nationwide survey of 481 edical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted.
Results: Of the 150 respondents, 65% (n 5 97) had 100,000 or more enrolled members and 35% (n 5 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%–12%) compared with nongovernmental plans (range, 24%–44%; P,.001). No significant regional differences for coverage policies were identified (P.05).
Conclusions: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.
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- Current National Health Insurance Coverage Policies for Breast and Ovarian Cancer Prophylactic Surgery
Annals of Surgical Oncology
Volume 7, Issue 5 , pp 325-332
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Prophylactic surgery
- Breast cancer
- Ovarian cancer
- Health insurance
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, University of California at San Francisco, San Francisco, California
- 4. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030
- 2. Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California
- 3. Cancer Risk Program, University of California at San Francisco, San Francisco, California