A bill that would require insurance companies to provide coverage of ultrasound or magnetic resonance imaging for women at increased risk of breast cancer is about to reach Gov. Tom Wolf.
The governor has indicated he will sign it into law.
The legislation, sponsored by Sen. Bob Mensch, R-Montgomery County, would make Pennsylvania one of only a few states that require insurers to pick up the high cost associated with these supplemental screenings for women with the following criteria:
- A personal or family history of breast cancer or genetic predisposition to it;
- Extremely dense breast tissue;
- Heterogeneously dense breast tissue with one other high-risk factor for breast cancer.
MRIs and ultrasound, with their clearer imaging, can detect breast cancer better than a mammogram because both cancer and density appear white on a mammogram. But MRIs and ultrasound can be expensive.
Ruth Gunnett of Southampton Township, Franklin County, can attest to the cost.
Having dense breast tissue as well as a family history, Gunnett, 36, said her doctor originally recommended that in addition to her annual mammogram that she have an MRI done every other year as a preventative measure. She took her doctor’s advice and had a MRI. The bill for that supplemental screening was nearly $4,000. Her insurance company said she would be responsible to pay it.
“After my first bill, I said to my doctor, um, you have to come up with a new plan because I can’t do that every other year,” Gunnett said. “I’m still actually paying on the one I had two years ago,”
Hearing that insurance companies in Pennsylvania will be compelled by this soon-to-be-enacted state law to pick up the cost of future MRIs is a huge relief, she said.
It will help others who have shared with her similar stories to the one she had. It also will help her younger sister and two daughters, who have a family history of breast cancer from both her and her husband’s side of the family.
“I’m willing to fight right now because they shouldn’t have to fight when their time comes to make sure they are doing these preventative screenings,” Gunnett said. “I don’t want them to be afraid of getting them nor do I want them to have to decide whether it’s financially something they can do. It’s something they should do.”
That’s why she said she told her personal story in a video shared by the Pennsylvania Breast Coalition to help garner legislative support for Mensch’s bill.
A recent study published in the Journal of the American Medical Association found that MRIs can detect 2.5 times more breast cancers than 3D mammograms in women with dense breasts.
“It will help women who need MRI or ultrasound find their breast cancer at an earlier treatable stage,” said Pat Halpin-Murphy, president and founder of the PA Breast Cancer Coalition. “When we say it’s important to diagnose at an earlier stage, it means you have a better chance of reduced severity of the treatment side effects and after effects.”
Once the governor signs this bill into law, it will take up to eight months for it to fully take effect.
In the meantime, Halpin-Murphy said the coalition will be undertaking an extensive education effort to ensure doctors are aware of the law and can put patients’ mind at ease about the potential cost of having the supplemental screenings if they are at high-risk of breast cancer.
Sen. Bob Mensch, R-Montgomery County, said about his bill requiring insurance companies to pay for MRIs and ultrasounds for women at high-risk of developing breast cancer, “I am confident that this legislation will make a difference in the lives." Screenshot from Pa. Senate website June 24, 2020
Mensch, the bill’s sponsor, has been a crusader for enhancing breast cancer detection efforts through the legislative process for the past decade. He authored a 2014 law that requires women to be provided breast density findings as part of their mammography results.
“Women who have extremely dense breast tissue are four to six times more likely to develop breast cancer,” he said, in remarks on the Senate floor on Wednesday in urging his colleagues to support the legislation. He said mammography screenings to detect cancer fail to detect tumors 40% of the time in women with extremely dense breast tissue.
“I am confident that this legislation will make a difference in the lives of many affected by this terrible disease,” he said.
The bill passed the House and Senate unanimously.
Jan Murphy may be reached at jmurphy@pennlive.com. Follow her on Twitter at @JanMurphy.
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