Proton therapy got positive billing at the recent Particle Therapy Cooperative Group, as researchers from across the country presented findings that showed proton therapy reduced potentially life-altering side effects and improved survival rates for cancer patients.
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She had discovered a lump in her right breast. She told no one—not even her daughters. (more…)
Glioblastoma is in the headlines these days thanks to a certain Senator from Arizona recently diagnosed with the disease. (more…)
Three bills aimed at helping patients get better insurance coverage for proton therapy are making the rounds of committees in Nashville this week, and Provision is urging patients and their friends and families to get involved.
For too many, trying to obtain the best treatment has brought them to blows with their insurance companies.
That was the case for Alexa Gash, who at 29 was diagnosed with throat cancer. Her father had recently suffered from the same diagnosis, and on the advice of the family’s physician, the couple began researching proton therapy. Because of Alexa’s age, they wanted to find a treatment that would be most effective but also spare her from unwanted long-term side effects. With conventional radiation, she risked permanent damage to her salivary glands, taste buds and teeth as well as the potential need for a feeding tube during and post-treatment due to a painful condition called mucositis caused by the excess radiation dose delivered outside of the tumor.
But, although Gash was determined a good candidate for proton therapy, her insurance company, BlueCross BlueShield of Tennessee, disagreed and denied her request for coverage. The company designated her treatment “experimental” and denied appeals to reconsider her case based on the potential ramifications of conventional radiation therapy.
Even though Medicare has covered proton therapy for more than 20 years and the National Comprehensive Cancer Network guidelines support proton therapy in the treatment of head and neck cancer, BlueCross simply said “No.”
In recognition of the gap in coverage and the beneficial impact that proton therapy can have for cancer patients, several legislators have introduced several bills in the Tennessee General Assembly that would require insurance companies to cover proton therapy under specified conditions at no additional cost to the insurance companies. They include:
• House Bill 0883 (Rep. John Holsclaw) & Senate Bill 0210 (Sen. Dr. Mark Green): Requires the state group health insurance program to cover hypofractionated proton therapy for treating cancer under certain conditions.
• House Bill 0523 (Rep. Bob Ramsey) & Senate Bill 0367 (Sen. Doug Overbey): Requires health insurance coverage to cover hypofractionated proton therapy in the same manner as it covers intensity modulated radiation therapy under certain conditions.
• House Bill 0899 (Rep. Mark Pody) & Senate Bill 0758 (Sen. Mae Beavers): Prohibits certain health benefit plans that provide coverage for cancer therapy from holding proton radiation therapy to a higher standard of clinical evidence for medical policy benefit coverage decisions than the health plan requires for coverage of any other radiation therapy treatment.
Currently, the insurance company lobby is fighting the legislation in spite of this increased support for proton therapy in both research and legislative circles, as well as the growing development of proton therapy centers around the world. Instead, they wear out their own insureds with an endless appeal process forcing frustrated patients, their families and healthcare providers to seek redress in the courts or the legislature.
Over the coming days and weeks, the bills will be heard in the Joint Pensions and Insurance Committee chaired by Chattanooga’s Sen. Bo Watson, the Senate Finance and Labor Committee chaired by Franklin’s Sen. Jack Johnson and the House Insurance and Banking Subcommittee chaired by Rep. Kelly Keisling from Pickett County, Tennessee. Sen. Johnson has previously spoken out in favor of proton therapy in publicly supporting the development of Tennessee’s third proton center in his district.
Find out more about how to contact your legislator and help promote these proton therapy bills.
CLICK HERE to watch the segment.
Nearly five years ago, 32-year-old Lindsay Rumberger was diagnosed with epithelioid hemangioendothelioma, a long name for a rare cancer that had originated in her liver and metastasized to her lungs. She underwent chemotherapy, but when a tumor close to her spine showed signs of growth, radiation was part of the recommended course. Because conventional radiation treatment threatened to cause peripheral damage to this most sensitive part of the body, her doctors recommended proton therapy instead. However, the insurance provider disagreed, calling the treatment “experimental” and refused coverage. (more…)
It was a promising year for legislation that would nudge insurance companies toward coverage of proton therapy for cancer patients.
However, after two bills promoting commercial payment for proton therapy were tabled in Tennessee House of Representatives committees, it’s the third year such bills have met with the same result. In both cases the House committees failed to take up a vote on the measures, leaving them to essentially die on the vine—at least for this legislative year.
While the measures didn’t pass, there were some positives takeaways. The bills were proposed by legislators themselves and had grassroots support. This showed that local awareness of proton therapy is growing and that our legislators are increasingly viewing it as an important cancer treatment option.
We encourage patients and their families to connect with their legislators, whatever the state, to promote the importance of proton therapy and encourage insurance coverage. A bill promoting the use of proton therapy passed in the Oklahoma state legislature last year and this year a proton therapy measure was proposed in Virginia, in addition to the two in Tennessee.
But legislation is not the only tactic for combatting the problem of insurance coverage.
Provision will work to increase public awareness of insurance companies’ failure to widely cover proton therapy for cancer patients—resulting in some patients seeking alternative treatments with undesirable side effects or scrambling to pay the costs out of their own pockets, according to Scott Warwick, vice president of program development and strategic initiatives for Provision Center for Proton Therapy
“We believe when the public realizes that insurance companies are preventing patients from getting the medical care they need, they will help put direct pressure on insurance companies to pay for proton therapy,” he says.
Another strategy is for companies that are self-insured is to request providers add proton therapy coverage to their policies. Provision, for example, covers its own employees for proton therapy through Cigna. Seventy percent of people covered for health care under commercial insurance are included in these company-funded plans, affording the opportunity for proton therapy to be included in the policy at little extra cost.
At the same time, he says, Provision will continue, as it has for the past several years, to dialogue with insurance companies in an effort to “come to agreement on reasonable coverage terms for proton therapy.”
Thanks to all the patients who contacted our legislators this year to urge passage of the bills. With a consolidated effort by continued patient support your voice will be heard. Please voice your opinion to legislators and your insurance companies in support of proton therapy, a life-changing cancer treatment.
Vice President Joe Biden’s recent commitment to lead a “moonshot” toward a cancer cure promises to deal a blow to the disease that has become the leading killer in the United States.
The initiative, kicked off last week, commits to bringing together a combination of therapies with “innovations in data and technology” to create treatment options that are ready for prime time—with the goal of making “a decade worth of advances in five years.”
Here at Provision, we couldn’t agree more. It’s something we work toward every day.
We believe the solution to a cancer cure is a combination of early detection along with both currently available and up-and-coming therapies that have the power to transform cancer treatment as we know it.
Here’s our view of a cancer-free future.
Ninety percent of cancer is treatable when detected early. If those at risk for a variety of cancers—particularly the big three: prostate, breast and lung—were screened appropriately, many of the cancer deaths we now mourn could be prevented.
For those who test positive for cancer, the healthcare system needs to, through research as well as financial support via insurance coverage, move toward treatments that kill the cancer but spare the patient and sustain quality of life.
Today, surgery, radiation and chemotherapy in various measures and combinations are the typical recipe for cancer care. All three of these remedies carry their own risks, from that of infection and complications in surgery to the collateral damage of radiation to the harsh toll chemotherapy takes on the entire body. Truly, the cure can be worse than the disease.
Here’s our vision of the future:
First, conventional radiation and most surgery should be replaced by proton therapy. Proton therapy is a proven, FDA-approved treatment option for those diagnosed with localized cancer such as found in the prostate, breast or brain. This non-invasive treatment reduces the side effects caused by conventional radiation therapy and surgery. A growing number of proton therapy centers are making this world-class option available to patients across the globe. We support their research in developing the best treatment plans and clinically demonstrating proton therapy’s effectiveness.
Second, immunotherapy offers the promise of a future without chemotherapy. By using the body’s own disease-fighting system to eradicate cancer, it eliminates the toxic, debilitating side effects now experienced by chemo patients and better prevents spread of the disease. Research should be dedicated to bringing this unique treatment to everyday application for cancers that now require chemotherapy.
And serious, strategic investment should be made in cancer prevention by encouraging healthy lifestyle choice and reducing environmental risks.
As Biden has said, for too long research has been stuck in silos, focused on narrow investigative tracks and lacking a clear, comprehensive, thoughtful vision that could actually move the needle on cancer mortality. Treatment is too often dictated by the financial interest of the health care industry rather than public and personal health priorities. Patients are too often relegated into the role of bystanders rather than active participants in their care.
We rejoice in the government’s fresh approach to this growing crisis. We are encouraged by the vice president’s willingness to seek the best answers to a problem that has touched his life and ours. We believe the answer is within reach—and we want to be a part of the solution. As Provision’s own ice-skating, cancer-surviving spokesman Scott Hamilton so eloquently puts it: “We want to help turn cancer upside down!”
Tennessee Senator Doug Overbey first learned about proton therapy several years ago when a church member had to travel out of state to receive the cancer treatment—and then mortgage her house to pay for it.
Today, Tennesseans can receive proton therapy closer to home, thanks to the Provision Center for Proton Therapy in Knoxville. But, unfortunately, some are still faced with paying for it themselves or going without.
For the past two years, Overbey has been fighting this inequity in the Tennessee General Assembly, and he’s not stopping now.
In a television interview with WATE “On Your Side” reporter Halley Holloway, Overbey pledged to continue fighting for insurance coverage that often eludes patients between ages 18 and 65 who are diagnosed with cancer. The interview was posted on the news station’s website along with a story about Tennessee breast cancer patient Lou Lovingood, whose Blue Cross Blue Shield insurance carrier had denied her claim for proton therapy treatment three times. Lovingood received treatment at Provision, where she was the center’s 500th patient.
Proton therapy has been used for treatment of cancer since the 1950s and approved for coverage by Medicare as well as by most insurers for pediatric cases since the early 1990s, when the modality became available at mainstream healthcare facilities. Overbey has supported two bills in the state legislature that would pave the way for private insurance to cover proton therapy for everyone—measures strongly opposed by insurance companies, particularly Blue Cross Blue Shield of Tennessee. (more…)
More than one-and-a-half million people were diagnosed with cancer last year even as a promising number of treatments are emerging to help combat the growing epidemic, according to a new cancer report released last week by the American Society of Clinical Oncology
However, access to treatment is being hampered by barriers to insurance coverage for those procedures, and a significant number of people find their insurance does not cover promising treatments at all. Cancer treatment centers are spending an increasing amount of time fighting insurance companies to receive coverage for their patients, and preauthorization requirements have been found to “increase demands on staff time, delay or interrupt patient care, decrease patient satisfaction, and complicate medical decision making,” according to the report.
Proton therapy is a clinically-proven, FDA-approved form of cancer treatment that is not an option for many patients because most private insurers do not provide reimbursement. New methods of delivering this special form of radiation therapy mean that, for most patients, proton therapy does not cost more than traditional radiation treatment. Because of the technology’s ability to direct radiation—in the form of protons—to the exact location of the tumor, treatment can be more effective, and patients experience many fewer side effects.
A bill making its way through the Tennessee Assembly gives doctors and patients the freedom to choose the best cancer regimen, including proton therapy. Today, patients who are not covered by Medicare or are not children are typically excluded.
We’re asking Tennesseans to take action to make proton therapy available to more cancer patients. Please contact your representative or senator this week to tell them to support the Cancer Patient Choice Act. See the Tennessee Cancer Patient Coalition website.
Please urge Tennessee lawmakers to make the right choice for cancer patients. Lives are at stake.
In Oklahoma, a similar bill has already passed the House of Representatives, unanimously, and is awaiting vote in the state Senate. Specifically, the Oklahoma legislation would prohibit insurers from requiring a higher standard of evidence for implementation of proton therapy than other cancer therapies, according to this article in The Edmond Sun.
In Tennessee, the proposed bill would provide for equal insurance coverage of proton therapy treatments as is currently available for traditional radiation. Proton therapy has been clinically proven effective in treatment of a variety of cancers including prostate, lung, liver, breast and head and neck cancers.
Although historically thought to cost more than traditional radiation therapy, newer methods allow this special form of radiation to be delivered in concentrated doses so that most patients can receive effective treatment of proton therapy for the same cost and over a shorter period of time.
Medicare covers proton therapy, but in most states private insurers do not. Tennessee and Oklahoma could break new ground by requiring insurers to allow patients and their doctors the option of choosing the best treatment for their disease.
Please visit the Tennessee Cancer Patient Coalition website. We ask that you contact your legislator and pledge support for the Cancer Patient Choice Act. Also, please join our Facebook community and share our message with your friends and family.