Blue Shield of California is the latest major insurer to scale back coverage for proton beam therapy for early stage prostate cancer, according to a Wall Street Journal report.
In letters sent this week to about 300 radiation oncology and urology practices in the state, the payer said it would stop covering proton beam therapy for early-stage prostate cancer, beginning at the end of October. The payer's chief health executive told the WSJ proton beam therapy has similar outcomes as other forms of radiation, but it is a lot more expensive.
Recent studies have found Medicare pays more than $32,000 for proton beam therapy compared with about $19,000 for more conventional radiation options, according to the report.
Blue Shield of California is the latest of a flurry of insurers to step back from proton beams. Aetna stopped covering proton beam therapy for prostate cancer Aug. 1. Cigna is planning to review its policy for proton beam coverage later this year. Regence — a Blue Cross Blue Shield plan in Oregon, Washington, Utah and Idaho — stopped covering the therapy three years ago. Pittsburgh-based Highmark and BCBS of Kansas City also have "long-standing positions against it," according to the report.
Other payers, like WellPoint, still cover proton beam therapy and negotiate down the costs of treatment. A spokesperson for the payer said it still considers the therapy "medically necessary" in certain situations. Medicare also continues to pay for the therapy.
There are currently 11 proton beam facilities operating in the United States, with at least 15 more in development. Rochester, Minn.-based Mayo Clinic and San Diego-based Scripps Health are two health systems planning or constructing proton beam facilities.
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