HARTFORD — Cigna has become the first national insurer to cover three-dimensional mammograms for routine breast cancer screening.
Medicare and Connecticut’s Medicaid program already cover the technology for routine mammograms, which are free to women 40 and older with insurance since Obamacare’s passage. But Cigna, Aetna, UnitedHealthcare and Anthem were hesitant, as there is not yet clear data to show that 3-D mammograms save more lives than traditional mammograms.
Cigna announced Tuesday that it would start to cover 3-D screens after the National Comprehensive Cancer Network, an alliance of major hospitals’ cancer centers, recommended the technology. Yale Cancer Center, which has participated in clinical trials testing the machines, is part of that network.
Yale participated in a study funded by Hologic, a 3-D mammogram manufacturer, that showed that for every 1,000 women screened, the combined tests found 4.1 cancers, compared to 2.9 with a traditional mammogram a year earlier.
Hologic, which manufactures the machines in Danbury, has been pushing companies to cover the new technology. The company, based in Marlborough, Mass., paid for billboards outside both Aetna and Cigna headquarters earlier this year, asking that they begin coverage.
The billboard outside Aetna now asks drivers to ask their companies to cover it.
Very large employers are generally self-insured, which means they can make their own decisions about what benefits to include at what level of cost-sharing. Just over half of people who have employer-provided insurance in Connecticut are with self-insured companies.
In the last legislative session, Connecticut passed a law that requires insurers to cover the 3-D test, if women ask for it, but they can charge co-pays. Traditional mammograms are free. But that law doesn’t affect the self-insured companies.
“We commend Cigna for its decision to cover 3-D mammograms for breast cancer screening, and are thrilled for the millions of women who now have access to this proven technology without co-pays or out-of-pocket expenses,” said Pete Valenti, Hologic division president. He urged Anthem, Aetna and UnitedHealthcare to change their policies.
Anthem spokeswoman Sarah Yeager said, “While [3-D mammograms] may offer promising advantages to conventional 2-D mammography, including decreased recall rates, there remain a number of questions about [it] that have not been fully addressed by the peer-reviewed, scientific literature,” such as whether it leads to more over-diagnosis of cancer that would not have advanced.
UnitedHealth said it continues to review the evidence for the new technology.
Aetna said it is also reviewing the policy, and that it bases decisions on peer-reviewed medical literature and evidence-based guidelines from the government or other sources. “We would not reconsider a policy as a result of a competitor’s actions,” spokesman Matthew Clyburn said.
Self-insured companies that use Cigna to administer benefits can still choose not to pay for the more expensive 3-D tests, but Cigna spokesman Mark Slitt said, “Typically if we have a coverage policy, employers will cover it.”
“We are always open to change based on new scientific evidence,” said Julie Kessel, Cigna’s senior medical director who oversees medical coverage policy. “We have a responsibility to our customers and clients to ensure that the medical treatments, tests and procedures they’re paying for have proven clinical value and will help improve their health and well-being. That’s a responsibility that we don’t take lightly.”
