Zone coverage.

Top Line: Breast tomosynthesis (multiple 2D-images to produce a 3D view) has gained favor over standard 2D-mammography in recent years as a more specific and sensitive breast cancer screening tool.

The Study: What’s less specific is guidance on how insurance should cover this more expensive type of mammography. Insurance coverage mandates can have both intended and unintended consequences. Most directly, it ensures people have access to a particular service. On the other hand, it can drive up insurance premiums as well as costs of the service via diminished negotiating power. Based on available data, between 2015-2019, 15 states mandated coverage of breast tomosynthesis screening and 34 states did not. ​​Here’s an analysis comparing use and costs of tomosynthesis breast cancer screening in these two cohorts of states, and the results point to: cover it, please. As expected, tomosynthesis use significantly increased (by a 9% shift in screening technique) two years after mandated coverage was instituted compared to states with no mandate. What’s more, the mean price of tomosynthesis screening actually decreased by nearly $40 with no detectable increase in out-of-pocket payments in states with mandated coverage.

TBL: The implications of mandated coverage are complicated, but this data suggests it may encourage a transition to tomosynthesis for breast cancer screening. Although, it will be important to assess benign biopsy rates and cancer treatment outcomes. | Richman, JAMA Netw Open 2022


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