Highmark Scraps Plan To Cut Coverage Of Propofol ; Anesthetic Will Continue Covering Most Popular Drug For Colonoscopies

Highmark will continue to cover the most popular anesthetic used for colonoscopies, scrapping previously announced plans to the contrary.

"The standard of care throughout most of Pennsylvania and most of the United States is Propofol for everyone," said Dr. Mark H. Johnston of Lancaster Gastroenterology Inc. on Harrisburg Pike. "It makes the experience so pleasant that people return."

The health insurer's proposed policy would have covered Propofol for colonoscopies and similar procedures only for patients for whom general anesthesia was deemed medically necessary.

Most patients never knew about the issue, Johnston said, but medical groups in Pennsylvania protested the policy, which Highmark said was designed to limit the risks of monitored anesthesia and in line with policies of "most leading national insurers."

The insurer agreed in May to delay the policy but, according to the Pennsylvania Medical Society, just recently announced that it will align its policy with Medicare, which starting Jan. 1 will include separately furnished anesthesia in its colonoscopy coverage and waive all associated coinsurance and deductibles.

Before Propofol came along, Johnston said, doctors used a narcotic and sedative combination to prepare patients for colonoscopies, but that can be less comfortable and can leave patients groggy.

With Propofol, patients are alert almost immediately and able to remember the doctor's instructions, Johnston said. However, because it must be administered by an anesthesiologist, it's more expensive.

Costs vary according to facility and payer, Johnston said, but at his group Propofol accounts for about a third of the cost of a colonoscopy, or several hundred dollars - enough that many patients probably wouldn't pick up the cost themselves for a screening procedure.

The U.S. Centers for Disease Control and Prevention said that among cancers that affect both men and women, colorectal cancer is the second leading killer in the U.S. But, it says, regular screening tests for everyone age 50 and older could prevent at last 60 percent of those deaths.