LUGPA Policy Update - State Efforts to Mandate No-Cost PSA Testing Coverage
April 2026
At-a-Glance Essentials
- What’s Changing: States are advancing bipartisan legislation to eliminate patient cost-sharing for PSA screening and, increasingly, follow-up diagnostic services.
- Why It Matters: Removing financial barriers improves early detection, supports evidence-based care, and addresses disparities in prostate cancer outcomes.
- Action Points: Engage in state advocacy, support community screening efforts, and monitor payer implementation.
- Key Trend: National momentum is accelerating, with a goal of enacting no-cost PSA screening policies in 25 states by 2030.
- Recent Win: Alabama became approximately the 10th state to enact comprehensive no-cost PSA screening (SB 19, signed into law in March 2026; effective dates vary, often Jan. 1 or Oct. 1, 2027).
Overview
LUGPA continues to track and support a growing wave of state legislation eliminating copays, deductibles, and coinsurance for prostate-specific antigen (PSA) screening and related diagnostics.
These reforms aim to bring prostate cancer screening in line with other no-cost preventive services, such as breast and colorectal cancer screening, where coverage parity already exists. This shift reflects increasing recognition of the clinical value of PSA testing when paired with shared decision-making and risk-based screening.
LUGPA’s advocacy aligns with:
- The federal PSA Screening for HIM Act
- Shared decision-making between patients and providers
- Evidence-based guidelines from the National Comprehensive Cancer Network (NCCN)
In partnership with groups like ZERO Prostate Cancer, these efforts focus on expanding access for high-risk populations, including men of African ancestry, those with family history, BRCA mutations, and veterans exposed to Agent Orange.
Several states, including New York, Illinois, Kentucky, and Tennessee, have already enacted similar policies. The 2026 legislative cycle demonstrates strong momentum, with multiple states advancing legislation and coordinated national advocacy efforts underway.
State Legislative Activity (March 2026)
Enacted / Signed
Advancing Legislation
- Arizona (HB 2617): Prohibits cost-sharing for high-risk diagnostic screening (effective 2027).
- Louisiana (SB 84): Passed Senate unanimously; pending House consideration.
- New Jersey (S1796 / A1142): Advanced out of committee; awaiting further hearings.
- South Carolina (S.1019): Newly introduced; includes PSA, DRE, and diagnostic labs aligned with NCCN Guidelines.
Uncertain Pathways
- Maine (LD 1502): Outlook unclear; cost defrayal remains a barrier.
- Pennsylvania (HB 281 / SB 447): Ongoing engagement; similar funding challenges.
Limited Movement
- Georgia (HB 373): Not advancing; advocacy shifting to education and community screenings.
- Ohio (HB 33): Limited legislative movement; advocacy ongoing through media and patient outreach.
Key Policy Considerations
Cost Defrayal
A central challenge is how insurers offset the cost of eliminating patient cost-sharing. States are exploring premium adjustments, state offsets, and risk-pooling strategies. While this can slow progress, early detection is widely expected to reduce long-term treatment costs.
Preventive Care Alignment
These policies aim to align PSA screening with other no-cost preventive services, though variation in federal recommendations—particularly from the U.S. Preventive Services Task Force (USPSTF)—continues to influence payer coverage decisions.
Equity and Access
Expanding no-cost screening is a targeted strategy to reduce disparities, particularly among high-risk populations who face higher incidence and mortality rates.
Implementation Considerations
As laws are enacted, key issues will include:
- Definitions of “high-risk” populations
- Network adequacy and access to urologists
- Potential utilization management requirements
- Integration with value-based care models
Why It Matters
Prostate cancer remains the second-leading cause of cancer death among American men, with increasing rates of advanced-stage diagnosis.
- Early Detection: PSA screening is associated with nearly 100% five-year survival when cancer is detected early.
- Access Barriers: Out-of-pocket costs continue to deter screening, particularly for vulnerable populations.
- Disparities: Black men face significantly higher incidence and mortality rates.
These reforms:
- Increase screening uptake and early diagnosis
- Promote guideline-concordant care
- Reduce long-term healthcare costs
- Improve equity in outcomes
Impact on LUGPA Members
Clinical Impact
- Increased PSA screening and patient engagement
- More early-stage diagnoses entering urology care
- Expanded use of surveillance, diagnostics, and targeted therapies
Practice and Financial Impact
- Growth in patient volume tied to preventive access
- Stronger alignment with value-based care models
- Reduced burden of advanced disease management
Advocacy Opportunities
- Engagement with policymakers and state agencies
- Participation in community screening initiatives
- Collaboration with advocacy organizations
While payer responses and cost defrayal mechanisms warrant monitoring, the overall impact strengthens the role of independent urology practices in prevention and early detection.
Next Steps
LUGPA will continue to:
- Monitor and report on state activity
- Coordinate advocacy with national and state partners
- Provide members with tools and engagement opportunities
Members are encouraged to:
- Engage with state policymakers
- Support local screening and awareness efforts
- Share patient stories and practice insights
LUGPA remains committed to advancing equitable, evidence-based prostate cancer care and ensuring independent urology practices remain central to these efforts.
For Further Information:
ZERO Prostate Cancer state legislation tracker.
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