The Los Angeles Times reports, “Blue Shield of California to curb coverage of pricey cancer therapy.”
“As hospitals race to offer the latest in high-tech care, a major California health insurer is pushing back and refusing to pay for some of the more expensive and controversial cancer treatments.
Blue Shield of California is taking on this high-cost radiation treatment just as Scripps Health in San Diego prepares to open a gleaming, $230-million proton beam therapy center this fall, only the second one in California and the 12th nationwide.
This week, Blue Shield began notifying doctors statewide of its new policy for early-stage prostate cancer patients, effective in October. The San Francisco insurer says there’s no scientific evidence to justify spending $30,000 more for proton beam treatment compared with the price it pays for other forms of radiation that deliver similar results.
This fight, pitting expensive new technology against the pressure to hold down costs, is flaring up nationwide as elite hospitals and medical-device makers look to build nearly 20 more of these proton centers in cities such as Phoenix, New York and the Washington area.
…a slew of studies have found that proton therapy doesn’t yield better results than older, cheaper alternatives. Some health-policy experts say hospitals’ constant pursuit of the fanciest gear and luxury amenities is one reason U.S. healthcare costs have been spiraling out of control.”
The Wall Street Journal added:
“At least three major insurers have recently decided to stop covering proton beam therapy for early stage prostate cancer or are reviewing their policy, saying that while it is an effective treatment, it is much less cost-effective when compared to the price of comparable treatments. …
Amitabh Chandra, professor of public policy at Harvard University and a critic of proton beam, said he’s “encouraged” by the steps some insurers are taking, but as long as Medicare pays for the therapy, it will be difficult for most insurers to deny coverage. “”
The story stated that, besides Blue Shield of California, Aetna, Regence (a BCBS plan in the Northwest), Highmark and BCBS of Kansas City all have policies against payment. Cigna was reported to be planning to review its policy later this year.
Former Boston hospital exec Paul Levy blogged:
“One of the mysteries of the medical arms race is why the CMS (Center for Medicare & Medicaid Services) administrators who have served in the Obama Administration (Don Berwick and Marilyn Taverner) never took action to eliminate the unjustified Medicare subsidy of high cost proton beam machines.
So, bravo to Blue Shield of California for doing just that, even in the face of inaction at the federal level.”
This is such an important story – demonstrating the hodge-podge decision-making about technology proliferation and cost control in the US healthcare non-system. Solid reporting by Ron Winslow of WSJ and Chad Terhune of the LA Times.
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