Significant Share of Colonoscopy Bowel Preparation Claims Involve Patient Cost-Sharing

A recent study published in the journal Gastroenterology sheds light on the financial burden faced by patients undergoing bowel preparation for screening colonoscopy. The research indicates that a notable portion of insurance claims for bowel prep medications include some form of cost-sharing from patients. This issue affects adults with commercial insurance, Medicare Part D, and Medicaid, with the extent of out-of-pocket costs varying across different plans.

The analysis reviewed over 2.5 million prescription claims and found that more than half of commercial claims (53%) and approximately 83% of Medicare claims involved patients paying out-of-pocket. Even among Medicaid patients, around 27% encountered costs. The study highlighted that lower-volume bowel preparation products tend to have higher patient cost-sharing compared to high-volume options.

In particular, the research revealed that 35% of high-volume product claims and 61% of low-volume product claims in commercial plans had some out-of-pocket expense. Among Medicare beneficiaries, these figures rose to 75% and 90%, respectively, while Medicaid claims showed 27% and 30%. The median costs for out-of-pocket expenses ranged from $1 to $60, depending on the plan type and product volume.

Authors emphasize that the findings highlight the importance of ensuring compliance with the Affordable Care Act, which mandates that colonoscopy preparations should be covered without cost to patients. Strengthening enforcement of this policy could improve access to screening, increase colorectal cancer detection rates, and promote equitable preventive health care. Notably, the study was funded in part by Sebela Pharmaceuticals.

This research underscores the need for healthcare payers to align coverage practices with evidence-based guidelines to reduce financial barriers to essential preventive procedures.