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Published in: Supportive Care in Cancer 3/2024

Open Access 01-03-2024 | Hodgkin Lymphoma | Research

Coverage for evidence-based cancer survivorship care services

Authors: Anne H. Blaes, Maysa M. Abu-Khalaf, Catherine M. Bender, Susan F. Dent, Chunkit Fung, Sophia K. Smith, Samantha Watson, Sweatha Katta, Janette K. Merrill, Shawna V. Hudson

Published in: Supportive Care in Cancer | Issue 3/2024

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Abstract

Purpose

The American Society of Clinical Oncology Cancer Survivorship Committee established a task force to determine which survivorship care services were being denied by public and private payers for coverage and reimbursement.

Methods

A quantitative survey instrument was developed to determine the clinical practice-reported rates of coverage denials for evidence-based cancer survivorship care services. Additionally, qualitative interviews were conducted to understand whether coverage denials were based on payer policies, cost-sharing, or prior authorization.

Results

Of 122 respondents from 50 states, respondents reported that coverage denials were common (“always,” “most of the time,” or “some of the time”) for maintenance therapies, screening for new primary cancers or cancer recurrence. Respondents reported that denials in coverage for maintenance therapies were highest for immunotherapy (41.74%) and maintenance chemotherapy (40.17%). Coverage denials for new primary cancer screenings were highest for Hodgkin lymphoma survivors needing a PET/CT scan (49.04%) and breast cancer survivors at a high risk of recurrence who needed an MRI (63.46%), respectively. More than half of survey respondents reported denials for symptom management and supportive care services. Fertility services, dental services when indicated, and mental health services were denied “always” or “most of the time” 23.1%, 22.5%, and 12.8%, respectively. Respondents reported they often had a process in place to automatically appeal denials for evidence-based services. The denial process, however, resulted in greater stress for the patient and provider.

Conclusion

Our study demonstrates that additional advocacy with payers is needed to ensure that reimbursement policies are consistent with evidence-based survivorship care services.
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Metadata
Title
Coverage for evidence-based cancer survivorship care services
Authors
Anne H. Blaes
Maysa M. Abu-Khalaf
Catherine M. Bender
Susan F. Dent
Chunkit Fung
Sophia K. Smith
Samantha Watson
Sweatha Katta
Janette K. Merrill
Shawna V. Hudson
Publication date
01-03-2024
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 3/2024
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-024-08359-9

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