Legislature mandates that state health insurance cover experimental cancer treatment

An experimental cancer treatment has won a rare endorsement from the Tennessee legislature despite some criticism, reports WPLN. The measure requires insurance coverage of proton therapy, which benefits a Knoxville-based company that is building a treatment center in Franklin.

Proton therapy is hyper-targeted radiation. The selling point is that it could help cancer patients avoid getting beamed on body parts where they don’t need it. But other than Medicare, insurance usually doesn’t cover the expensive regimen. Knoxville-based Provision Health Services has admitted this is why its only treatment center is running at half capacity, even as it builds a second in Franklin, scheduled to open later this year.

So Provision has been lobbying the state insurance plan, which covers 300,000 government workers and teachers. But the state has rejected paying for proton therapy except for a few cases, like prostate cancer. Lawmakers were the company’s last resort, with a bill that would require government insurance to cover the regimen.

(It’s SB367, sponsored by Rep. Bob Ramsey (R-Maryville) and Sen. Mark Green (R-Ashland City. The vote was 29-1 in the Senate; 82-13 in the House and it awaits the governor’s signature.)

At a hearing, executive director Laurie Lee of the state’s benefits and administration agency warned legislators not to intervene.

“For us, it’s a dangerous precedent,” Lee said, “putting in statute to cover something that’s experimental, investigational, that down the road may prove out to have dangerous side effects.”

Rather than experimental, Provision calls the therapy “state of the art.” And the biggest names in cancer treatment are adopting the pricey technology — MD Anderson, Mayo Clinic, St. Jude. But the necessary machinery is so costly, there are currently only about two-dozen centers around the country. The latest studies showing that proton therapy can be twice as expensive as more conventional treatment.

“We are not opposed to proton therapy. We cover proton therapy,” Lee said. “We’re not opposed to continually reviewing the application of this new and changing technology, but to do so in a way that is safe for our patients and follows the same process that we use for covering all new technologies.”

… Most of those voting against the legislation were Republican members of the House Insurance and Banking Committee, which spent more time than anyone debating and studying the proposal.

The company’s CEO, Tom Welch, endured multiple days of questioning in that committee, and eventually convinced a slim majority to go along. Provision intends to build on the favorable decision and approach more companies about adding coverage.

“If the state’s largest employer thinks its important and is willing to do it, and the legislature thinks it’s important, then we’re hopeful that other companies realize they can do it and will think it’s important,” Welch tells WPLN.

Note: The bill says that the charges billed to the state’s insurance plan for proton therapy cannot exceed what would be paid for more conventional treatment, thus avoiding increased state spending — and a “fiscal note” that would have decreased prospects for passage.