Aetna, one of the leading national private health plan managers, has joined with other insurers, such as WellPoint and Humana, to declare it will not cover a powerful anesthetic, Propofol, used to eliminate discomfort during a colonoscopy. A colonoscopy is a common form of colon cancer screening which allows doctors to explore the small intestine to identify and remove cancerous tumors before becoming dangerous. Aetna has deemed Propofol as being “medically unnecessary” for the procedure and will stop insuring the use of it on April 1, 2008. However, exceptions are being made for people over 65, pregnant women, and patients with illnesses that cannot use other more risky drugs.
The price of using Propofol includes a licensed anesthesiologist because of the complex nature of the drug. It can add from $300- $1,000 to a hospital bill. Aetna argues that the price being paid for the anesthetic is greater than the benefits received for the patient and since millions of colonoscopies are being performed each year, it is costing the insurance companies millions of unnecessary dollars. All three leading associations for specialists who perform colonoscopies have concurred that the anesthetic is not needed for routine colonoscopy procedures.
Critics see this decision as a step back in the fight to prevent the third most prevalent cause of death by cancer in the United States. With insurance companies not covering Propofol, they anticipate less people getting screened for the cancer or relying on less invasive, and ultimately less reliable, means of detecting the disease. Doctors also find the drug necessary since it calms the patient down and can allow a more thorough examination. Other insurance companies such as United Healthcare have said they have no intentions to follow suit in not covering Propofol.
For more information on this subject, please refer to the section on Drugs, Medical Devices and Implants.