More than a half dozen large private health insurance companies have agreed to cover the cost of navigators who guide cancer patients and their families through the confusing array of medical appointments and drug treatments that follow a diagnosis.
The expansion of the cancer navigator program, part of President Joe Biden's ambitious Cancer Moonshot, is among a handful of health initiatives unveiled this week to coincide with the president's State of the Union address.
Advocates say navigators help guide patients and their families through medical appointments and choices they face after a cancer diagnosis. Administration officials cited research that found navigators help reduce how long people wait between diagnosis and treatment. Patients are also more likely to complete treatment when they work with a navigator.
Beginning this year, the Centers for Medicare & Medicaid Services announced it would cover navigation services for older Americans on Medicare. The agency also established billing codes for hospitals and doctors to bill health insurance companies for navigator services.
The Biden administration announced that seven large private health insurance companies have agreed to cover navigator services: Aetna, Blue Cross Blue Shield of Minnesota, Elevance Health, Health Alliance Plan, Humana, Priority Health and Select Health.
In addition, 40 cancer care centers and clinics will extend navigator services to patients. The list includes high-profile cancer care centers such as Dana-Farber Cancer Institute in Boston, the Duke Cancer Institute, Northwell Health and the Mayo Clinic.
"This is about making sure that a growing number of Americans can get access as they need it," Arati Prabhakar, director of the White House Office of Science and Technology Policy, told USA TODAY. "The companies that have signed up to provide insurance coverage for these services ... reach 150 million Americans."
Patient advocates who are familiar with the difficulties of managing a cancer diagnosis in the nation's fragmented health care system said navigators play a critical role.
Kathy Giusti, a two-time cancer survivor and co-founder of the Multiple Myeloma Research Foundation, often talks about the challenges patients face after a cancer diagnosis. She described the U.S. health care system as "vast, fragmented and challenging" and worries patients are missing out on the best treatments science is delivering.
She said Medicare's coverage of navigators and the broader rollout with the private insurers will help patients.
"Trained navigators will ease the burden placed on patients and their caregivers," said Giusti, whose book, "Fatal to Fearless: 12 Steps to Beating Cancer in a Broken Medical System," describes her cancer journey and provides tips for others. "This is a positive short-term solution to a much longer-term problem."
Navigators can educate patients on how to advocate for and better coordinate care. Specially trained individuals also can connect patients and their families to social services to address food and housing needs and transportation.
Prabhakar said people face so many decisions and challenges after a cancer diagnosis. They have to schedule appointments and arrange transportation. Some patients also seek access to new drugs or treatments being studied in clinical trials.
"The moment you hear the doctor say the C word, your world starts spinning apart," said Prabhakar, Biden's chief advisor for science and technology. "Having a helper by your side brings a measure of calm to a difficult time."
Launched during President Barack Obama's presidency, the Cancer Moonshot was part of the 21st Century Cures Act passed in 2016. Biden reinvigorated the effort in 2022 and established goals to cut age-adjusted death rate from cancer by 50% within 25 years and to support patients living with cancer and their caregivers.
The American Cancer Society projects 611,720 people will die of cancer this year, a slight increase from it's estimate a year ago. The cancer death rate dropped 33% between 1991 and 2021, largely driven by lower smoking rates, earlier detection and improved treatments.
In Thursday's State of the Union, Biden touted plans to more than double the number of drugs that Medicare can negotiate prices for – his goal is 50 drugs yearly, up from 20 drugs.
For the first time, a 2022 federal law has empowered CMS to negotiate lower Medicare drug prices. The Biden administration has named the first 10 diabetes, heart disease and cancer drugs that Medicare will negotiate, but the price changes on those drugs won’t take effect until 2026. The program will ramp up to 15 negotiated drugs in 2027 and 2028 and 20 drugs each year that follows.
Earlier this week, administration officials announced Biden would ask Congress to limit Medicare patients' out-of-pocket costs to $2 for "high-value generic drugs."
The U.S. Department of Health and Human Services plans to publish a list of proposed $2 generics such as statins to treat high cholesterol and beta-blockers for high blood pressure.
Drug companies and industry allies have filed nine lawsuits challenging different aspects of the Inflation Reduction Act. Those legal challenges haven't delayed the administration's efforts to negotiate cost savings.
The Pharmaceutical Research and Manufacturers of America, a trade group representing drug manufacturers, said the drug price negotiations threaten drug innovation.
The Inflation Reduction Act is "stifling lifesaving research, like the very research needed to get the president’s Cancer Moonshot off the ground, and creating access barriers for patients," PhRMA President and CEO Stephen J. Ubl said in a statement.