WASHINGTON, D.C.— The Biden Cancer Moonshot announced today the expansion of coverage for patient navigation services in plans from seven health insurance companies, as well as actions more than 40 comprehensive cancer centers and community oncology practices across the country are taking to help patients be reimbursed for these critical services.
“Navigating a confusing and complex health care system after receiving a cancer diagnosis is difficult for anyone. We’re encouraged to hear coverage for patient navigation is expanding in commercial health insurance plans and comprehensive cancer centers, and community oncology clinics are committed to using patient navigation codes to increase coverage,” said Dr. Karen E. Knudsen, CEO of the American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN). “Increasing coverage of patient navigation will not only improve the patient experience, but improve patient outcomes, bringing us closer to ending cancer as we know it, for everyone.”
Reimbursement for non-clinical navigation in Medicare, which took effect on January 1, 2024, and which ACS CAN advocated for, was a meaningful first step toward expanded and sustainable access to critical services for patients with cancer and other serious illnesses and today’s announcement takes us further on that path. Evidence shows that patient navigation can bridge a number of gaps and address diverse needs across patient populations. When it comes to cancer care, patient navigation offers support to manage and traverse an often overwhelming and scary prognosis by increasing understanding of treatment options. Oncology navigation can improve patient outcomes, reduce unnecessary treatment costs and increase patient satisfaction. It also helps address health-related social needs and reduce health disparities by providing access to disease prevention education, conducting community outreach and facilitating public education campaigns.
“Getting the right care is particularly challenging for patients living in communities that have been historically under resourced, who experience numerous barriers to getting the care they need when they need it,” said Lisa Lacasse, president of ACS CAN. “Patient navigation can help reduce these disparities and expanding coverage among private payers is a step toward increasing access to it.”
While patient navigation is a widely recognized intervention in addressing cancers disparities, funding of and equitable access to navigation services has been a challenge.
According to a 2022 survey by ACS CAN, an overwhelming majority of patients and survivors (91%) agree that having access to a patient navigator is very important for cancer patients. However, only 54% of surveyed individuals had encountered a patient navigator.
ACS and ACS CAN have been long-standing advocates of the important role patient navigation services play in surviving cancer. ACS CAN advocated for the reimbursement strategy within the Centers for Medicaid and Medicare Services’ final rule announced in November of 2023.
ACS has funded patient navigators and navigation programs, developed navigation training curricula and united organizations through the American Cancer Society National Navigation Roundtable. To help maximize the use of oncology patient navigation across the nation, ACS is now expanding its work to include the American Cancer Society Leadership in Oncology Navigation (ACS LION ™) program, a standardized training and credentialing program for professional navigators that will meet the CMS requirements for reimbursement. Through focusing on credentialing and working with oncology organizations on capacity building, the goal of the program is to improve comprehensive care for oncology patients and their families by supporting the advancement and sustainability of the navigation profession.
“Expanding access to navigators who can help patients overcome barriers to care and improve health outcomes is a critical component to changing the landscape of cancer in this country,” said Dr. Knudsen. “ACS CAN will continue to work with the administration, Congress and state lawmakers to ensure everyone has access to patient navigation.”
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