In 2023, several state legislatures took significant steps to enhance access to breast cancer diagnostic examinations and supplemental imaging services, aiming to alleviate or eliminate cost-sharing requirements for patients and ensure equitable coverage for essential breast health services. Each state's radiological society collaborated with various stakeholders in support of these initiatives. Many measures underscored the need to expand insurance coverage beyond mammogram screenings, as recommended by the American Cancer Society, particularly for high-risk patients and individuals with dense breast tissue. Without such coverage, the costs of supplemental examinations or follow-up diagnostic screenings can become prohibitively high, discouraging individuals from seeking potentially lifesaving tests. A by the Susan G. Komen Breast Cancer Foundation, often cited in state legislative testimony, notes cost as a primary reason for women avoiding recommended diagnostic imaging.
Here is an overview of the key bills related to breast health that were enacted in 2023:
Arizona
updated recommendations for breast examinations and cancer screenings in the current statute, with a focus on early detection and diagnosis. It also updated definitions to ensure that individuals at higher risk for breast cancer, whether due to genetic factors, family history or breast tissue density, have access to a broader range of screening methods, and that the timing and frequency of these screenings follow established guidelines from authoritative sources like the National Comprehensive Cancer Network.
Delaware
requires that all insurance policies issued or renewed in Delaware include coverage of supplemental and diagnostic breast examinations on terms that are at least as favorable as the coverage of annual screening mammograms. The act covers all group, blanket and individual health insurance policies, as well as the state employee healthcare plan and Medicaid.
Georgia
empowers the Commissioner of Insurance to establish rules and regulations governing cost-sharing requirements for diagnostic and supplemental breast screening examinations.
Maryland
and prohibit insurers from imposing co-payments, coinsurance, or deductible requirements for diagnostic and supplemental breast examinations. MD HB 376 defines diagnostic breast examination as a medically necessary evaluation of the breast, which includes examinations using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound. Supplemental breast examination is defined as a medically necessary breast screening when there are no prior abnormalities but there is a personal or family medical history or additional risk factors. The new law calls on the Maryland Health Care Commission to study and report to the governor, the Senate Finance Committee, and the House Health and Government Operations Committee about the financial impact of eliminating health insurance cost–sharing for diagnostic image-guided biopsies for breast cancer.
Montana
revises insurance coverage related to breast examinations, emphasizing equitable access to diagnostic breast examinations using various methods and updates definitions for diagnostic breast examination and supplemental breast examination. The definition of diagnostic breast examination now encompasses examinations performed using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound. The definition of supplemental breast examination also now encompasses examinations performed using breast magnetic resonance imaging or breast ultrasound.
New Mexico
requires coverage for diagnostic and supplemental breast examinations without cost sharing, promoting access to medically necessary and appropriate breast examinations.
North Dakota
directs Legislative Management to consider studying whether health insurance should provide coverage for diagnostic and supplemental breast examinations without imposing cost-sharing requirements. Legislative Management is tasked with reporting findings and recommendations, together with any legislation required to implement the recommendations, to the next session’s Legislative Assembly.
Oregon
prohibits health benefit plans that reimburse the cost of diagnostic or supplemental breast examinations from imposing a deductible, coinsurance, copayment, or other out-of-pocket expense for a medically necessary diagnostic or supplemental breast examination. Key terms, including "diagnostic breast examination" and "supplemental breast examination" are defined. Diagnostic breast examinations encompass examinations that evaluate breast abnormalities detected or suspected during breast cancer screening, and these examinations can include diagnostic mammography, breast magnetic resonance imaging or breast ultrasound. Supplemental breast examinations involve breast screenings for individuals with no suspected abnormalities, based on personal or family medical history, or risk factors for breast cancer. This is effective beginning Jan. 1, 2024.
Rhode Island
mandates insurance coverage for any additional screenings deemed medically necessary for individuals who have received notice of dense breast tissue. Notably, the policies must cover two screening mammograms per year when recommended by a physician for women who have been treated for breast cancer within the last five years or are at high risk due to factors such as genetic predisposition or dense breast tissue. Additionally, other medically necessary screenings, such as magnetic resonance imaging or ultrasound, must be covered for individuals with dense breast tissue.
Tennessee
and require health benefit plans to provide coverage for diagnostic imaging and supplemental breast screening without imposing cost sharing on the patient. "Cost-sharing requirement" is defined to encompass deductibles, coinsurance, copayments and maximum limitations on these out-of-pocket expenses. The law went into effect on August 9.
Washington
addresses cost sharing for diagnostic and supplemental breast examinations, promoting access to diagnostic breast imaging services without financial obstacles. Except for grandfathered plans, the measure stipulates that health carriers may not impose cost sharing requirements. Additionally, "diagnostic breast examination" is defined as a medically necessary and appropriate examination of the breast, which includes diagnostic mammography, digital breast tomosynthesis (three-dimensional mammography), breast magnetic resonance imaging, or breast ultrasound, and is used to evaluate an abnormality that is either seen or suspected based on a screening examination for breast cancer, or detected through another means of examination. "Supplemental breast examination" refers to a medically necessary and appropriate examination of the breast. This type of examination includes breast magnetic resonance imaging or breast ultrasound, and is used for two primary purposes: to screen for breast cancer when there is no abnormality seen or suspected in the breast, or be based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.
These legislative actions represent significant progress at the state level in removing barriers to breast cancer screening and diagnosis, with state radiological societies playing a pivotal role in collaborating with stakeholders and legislators in their respective states. It is anticipated that the 2024 legislative session will see additional states pursuing similar measures in this ongoing effort.
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