Insurers doing what feds haven’t in refusing to pay for proton beam therapy

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.


Follow us on Twitter:

and on Facebook.


You might also like

Comments (4)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Susan Fitzgerald

September 6, 2013 at 12:29 pm

My favorite quote from the WSJ story is the guy from a proton beam association: “There would be no debate if costs were the same as conventional X-ray radiation.”

Duh! Vastly higher cost without corresponding increase in outcomes is a problem. I have to assume the reporters intended irony in chosing this quote to end the story.

Gary Schwitzer

September 10, 2013 at 9:00 am

Dr. Rita Redberg of the University of California, San Francisco, and editor of JAMA Internal Medicine, wrote this to me in response to our blog post:

“I was a bit more critical of the WSJ article

I would have titled – Insurers Question Millions of dollars spent for Unproven and Potentially Harmful Cancer Therapy.

While he eventually gets to the fact that there is NO evidence showing any benefit of proton therapy for early stage cancer compared to the many other (unproven) therapies already on the market, he never mentions that none of these therapies have been shown to be better than doing nothing (“watchful waiting” or conservative therapy) and all have harms, many serious such as incontinence or impotence or worse. Also, he neglects to mention that after a thorough review of all of the evidence the USPSTF has recommended that we stop screening for prostate cancer, because there is no benfit and many potential harms.”