PSA Screening for HIM Act

Bill Summary: PSA Screening for HIM Act (S. 297)

Overview

The Prostate-Specific Antigen (PSA) Screening for High-risk Insured Men Act, or the PSA Screening for HIM Act, is a legislative proposal designed to increase access to early prostate cancer detection for men at higher risk. The bill seeks to eliminate financial barriers to screening by requiring health insurance providers to cover PSA screenings without cost-sharing (such as copayments or deductibles) for specific high-risk populations.

Purpose and Intent

The primary goal of the bill is to improve survival rates for prostate cancer by facilitating early detection. The legislation is based on several critical findings:
* Survival Gap: Prostate cancer has a survival rate near 100% when detected in early stages, but only 37% when detected in late stages.
* Disproportionate Impact: African-American men are 70% more likely to be diagnosed with prostate cancer and 2.1 times more likely to die from it than White men.
* Genetic Risk: Men with a first-degree relative (father or brother) with prostate cancer are more than twice as likely to be diagnosed.
* Economic Impact: Treating metastatic (late-stage) cancer is significantly more expensive for the healthcare system than treating localized, early-stage cancer.

Key Provisions

Mandatory Insurance Coverage

The bill amends the Public Health Service Act to require group health plans and health insurance issuers (both group and individual) to provide coverage for prostate cancer screenings without cost-sharing for men who meet the following criteria:
* Age: 40 years of age or older.
* Risk Status: Identified as "high risk," which explicitly includes:
* African-American men.
* Men with a family history of prostate cancer.

Definition of Family History

To ensure clarity in coverage, the bill defines "family history" as having a first-degree relative who:
* Was diagnosed with or developed prostate cancer.
* Died as a result of prostate cancer.
* Was diagnosed with a cancer associated with an increased risk of prostate cancer.
* Possesses a genetic alteration associated with an increased risk of prostate cancer.

Additional Clarifications

• Breast Cancer Screening: The bill includes a technical clarification that current USPSTF recommendations for breast cancer screening (excluding those from around November 2009) remain the applicable standards.
• Flexibility for Insurers: The bill does not prevent insurance plans from offering additional services beyond those required by the act or those recommended by the USPSTF.

Who Is Affected?

• High-Risk Men: Men aged 40+ who are African-American or have a family history of the disease will gain no-cost access to screenings.
• Health Insurance Issuers: Group and individual health insurance providers must update their coverage policies to eliminate cost-sharing for these specific screenings.
• Healthcare Providers: Primary care physicians and urologists may see an increase in screening requests for high-risk patients.

Timeline and Procedural Status

• Effective Date: The amendments apply to plan years beginning on or after January 1, 2025.
• Current Status: The bill was introduced in January 2025 and referred to the Committee on Health, Education, Labor, and Pensions, which held hearings on March 19, 2026.