UPMC supports the recent passage of Pennsylvania Senate Bill 8, a groundbreaking breast cancer screening bill. It will provide access to lifesaving care for high-risk patients.
Pennsylvania is one of four states leading the way to remove insurance barriers to breast cancer screening tests. This will ensure expanded access for all women, leading to earlier detections and treatments. The other states are Illinois, Connecticut, and Maryland.
The state Senate and House both passed Senate Bill 8 unanimously in April 2023. In May, it became the first bill signed into law by newly elected Gov. Josh Shapiro.
Senate Bill 8 is the nation’s first comprehensive breast cancer screening bill to eliminate out-of-pocket costs associated with BRCA genetic testing and counseling. BRCA genetic testing can reveal if people have inherited a gene change that puts them at higher risk for breast cancer.
Kim Ward, the state Senate president pro tempore, sponsored Senate Bill 8. Soon after she became the state’s first female Senate majority leader in 2020, Sen. Ward was diagnosed with breast cancer. The frustrations she experienced before battling and beating her cancer led to the drafting of Senate Bill 8.
“With approximately 14,000 new cases of breast cancer per year in Pennsylvania, what this legislature did by getting the bill to Gov. Shapiro for his signature will have a huge positive effect on women’s health and lives,” Sen. Ward says. She was present when Gov. Shapiro signed the bill.
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How Senate Bill 8 Eliminates Out-of-Pocket Expenses
The legislation expands upon Act 52 of 2020. That legislation required insurers to cover breast MRIs and ultrasounds for women with high-risk factors for the first time.
Senate Bill 8 is step two. It eliminates costs such as co-pays, deductibles, and co-insurance for screenings and BRCA-related genetic testing and counseling.
High-risk conditions covered by the bill include:
- Dense breast tissue.
- Family history of breast cancer.
- Genetic predisposition.
- Personal history of breast cancer.
- Prior radiation therapy.
“This landmark legislation removes cost barriers for patients who may benefit from supplemental breast cancer screening,” says Margarita Zuley, MD, chief, Breast Imaging, UPMC Magee-Womens Hospital. “Elimination of this financial responsibility improves the opportunity for true equity in breast cancer diagnoses and outcomes for all individuals.”
Mammography is proven to reduce deaths due to breast cancer. But not all women benefit equally.
Some women just don’t schedule or show up for mammograms, says LaJuana Fuller, director, Women’s Imaging, UPMC Magee.
“A lot of times, people who cannot afford to pay won’t come,” she says. “And, so, then what happens? You have people walking around potentially with a cancer that’s not diagnosed.”
Providing Access to Lifesaving Breast Screenings
UPMC recently launched supplemental abbreviated screening breast MRI for people at higher risk due to a personal or family history of breast cancer or breast density. Senate Bill 8 encourages participation in this potentially lifesaving care.
“About 40% of women have dense breasts, which can hide cancer on a mammogram and also increase the risk of developing breast cancer,” says Wendie Berg, MD, radiologist, UPMC Magee.
“Women with dense breasts — especially those who also have a family history of breast cancer, prior breast cancer, or atypical biopsy — may benefit from adding screening MRI to their annual testing,” says Dr. Berg, who specializes in breast imaging.
Dr. Berg recommends that all women should have risk assessment by age 25, with possible genetic testing. She says women who are at high-risk should start screening early (sometimes by age 25).
“This risk assessment is also covered by this important legislation,” Dr. Berg says.
In addition, UPMC Health Plan covers yearly mammograms for women of all ages. For in-network providers, we offer coverage without cost-sharing, age limits, or authorization requirements. For women over the age of 40 or for whom additional imaging is recommended, no-cost coverage of follow-up screening services is also available.
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