Bill eliminating patient costs for certain cancer tests, screenings clears Pa. Senate committee

HARRISBURG — Separate bills that would eliminate out-of-pocket costs for certain genetic testing and supplemental breast cancer screenings moved through the Pennsylvania Senate committee on Banking & Insurance this week and are in line for a potential vote by the upper house of the General Assembly.

Both the House and Senate each have six session days remaining in the current session. If either or both bills are to be adopted, lawmakers must move quickly. Should neither be approved and signed into law, they'd have to be reintroduced in 2023.

Senate Majority Leader Kim Ward, R-Westmoreland, sponsored Senate Bill 1330. It aims to restrict insurers from charging patients for any costs related to genetic counseling and, if indicated after counseling, genetic testing for BRCA 1 and BRCA 2 gene mutations.

According to the Centers for Disease Control and Prevention, the two genes can protect against certain cancers, however, mutations of either cause them to work improperly and raise the risk of developing breast, ovarian and other cancers. Not everyone who inherits a mutation of either gene will develop cancer, the CDC states.

About 3% of breast cancers, or 7,500 women annually, and 10% of ovarian cancers, or about 2,000 women annually, develop from inherited mutations, according to the CDC.

The mutations greatly enhance the cancer risk for those with the mutations: up to 72% and 69%, respectively, for the two mutations when it comes to breast cancer; up to 44% and 17%, respectively, for ovarian cancer, per the National Cancer Institute.

Men are also at risk. Citing the Penn Medicine's Basser Center for BRCA, a statement from Ward said nearly 25% of men with BRCA mutations develop prostate cancer.

"Early detection saves lives," Ward said in a joint statement on the bills. "As an individual who benefited from genetic testing, I can say this legislation will go a long way in helping individuals to remain vigilant about getting regular testing or help best determine treatment."

Senate Bill 1225 is sponsored by Sen. Bob Mensch, R-Berks. The bill calls for health insurers to cover costs of an annual supplemental breast screening for women with a high lifetime risk of breast cancer. Insurers couldn't apply the cost toward a deductible or coinsurance or charge a copay, according to the bill.

MRI and ultrasound coverage under Act 52 of 2020 would extend to women with a personal history of atypical breast histologies, personal or family history of breast cancer, genetic predisposition for breast cancer, prior therapeutic thoracic radiation therapy, extremely dense or heterogeneously dense breast tissue based on breast composition categories of the Breast Imaging and Reporting Data System established by the American College of Radiology, the bill's memo states.

Supplemental screening is necessary, according to the joint statement, because of failed early detection by screening mammography among women with dense breasts and those at high lifetime risk of breast cancer.

"Research and experience tell us that the best way to have a fighting chance at beating this deadly disease is knowing the risk factors and early detection. Both bills remove barriers to early detection experienced by thousands of Pennsylvanians, and (this week's committee) vote signals another monumental step taken by this Legislature to fight, and hopefully eventually eliminate, breast cancer," Mensch said.

A study published by the Journal of the American Medical Association, a peer-reviewed medical journal, found that MRIs were substantially more effective in detecting breast cancer than 3D mammograms.

Another study, this one published in the Journal of the National Cancer Institute, found that the mean cost of an MRI was $549 out of pocket for women whose insurance had a high deductible. The study looked at insurance data between 2009 and 2017 and included more than 16,000 patients. It found that the rate of those without out-of-pocket costs dropped from 43% in 2009 to 26% in 2017.

The Brem Foundation to Defeat Breast Cancer in Maryland estimates the average cost at $1,084 and there are many media accounts of women being billed much more.

Pat Halpin-Murphy, president and founder of the Pennsylvania Breast Cancer Coalition, saluted both Ward and Mensch along with the Banking & Insurance Committee chairs, Sen. John DiSanto, R-Dauphin, and Sen. Sharif Street, D-Philadelphia, for acting on the proposed legislation.

"When it passes, this legislation will mark another major step forward in our joint efforts to ensure early detection is possible for every woman in Pennsylvania," Halpin-Murphy said of the genetic testing bill before shifting to the bill on no-cost MRI and ultrasound. "There are women at high-risk living with breast cancer right now in our state, and they don't know it, because they can't afford the MRI that will find it. Senate Bill 1225 will change that. Cost should not be a barrier for a woman at high-risk to get the breast MRI that could save her life."