In a recent letter, ¶¶Òô´ó¹Ï and other members of the colorectal cancer community asked the Centers for Medicare and Medicaid Services to clarify its guidance on bowel prep coverage to ensure all Food and Drug Administration-approved bowel prep medications meeting medical efficacy standards are covered without patient cost-sharing for all screening colonoscopies and follow-up colonoscopies after an abnormal non-invasive screening test.
The letter cites a 2025 that highlights only 17 percent of Medicare beneficiaries receive bowel preparations without cost sharing.
The Affordable Care Act, and its, considers bowel preparation medications as integral to preventive screening colonoscopy, and therefore, are required to be covered without patient cost sharing. However, allow health plans to use reasonable medical management techniques to determine any coverage limitations. For example, plans may cover a generic drug without cost-sharing and impose cost-sharing for equivalent branded drugs. However, plans are required to have a mechanism for waiving cost-sharing for a non-preferred product if an individual’s health care provider finds the generic version medically inappropriate.