by
John R. Fischer, Senior Reporter | January 07, 2020
State employee health plans are now required by
law in Tennessee to cover hypofractionated proton
therapy
A new law in Tennessee guarantees affordable access to proton therapy for state employees.
Taking effect on January 1, the Proton Therapy Access Act mandates that any cancer patient with a state employee health plan will be covered for hypofractionated proton therapy if the physician and patient believe it to be a beneficial treatment,
according to CBS affiliate, WVLT8 News.
"This new law will provide access to lifesaving, advanced cancer treatment to members of the Tennessee State plan that may not have been eligible for proton therapy prior to this law," Ben Frank, president of Provision CARES Proton Therapy Nashville, told HCB News. "Beyond members of the Tennessee State plan, we are hoping this regulation will shine a light on the hurdles that Tennessee cancer patients frequently have to navigate when they receive a catastrophic diagnosis."
The law was sponsored by Senator Becky Massey (R-Knoxville), who said in a statement that the treatment would be covered at no additional cost to the state, cancer patients or insurance companies.
An advanced form of radiation therapy, proton therapy enables users to target and more accurately destroy tumors, while reducing exposure of normal tissue to radiation, thereby minimizing incurred side effects. With hypofractionation, clinicians can administer higher daily doses in fewer treatments, providing the patient with the same biological equivalent dose. It also, in many instances, brings the cost of proton therapy down to or close to that of IMRT, according to Scott Warwick, the former executive director of the National Association of Proton Therapy.
Warwick told HCB News in March 2018 that the biggest barrier to proton therapy was
obtaining coverage for its many uses. “The biggest challenge is expanding commercial coverage for more cancer indications. Our members are striving to meet that challenge by continuing to develop the clinical evidence demonstrating the therapeutic benefits of proton therapy. We’re also exploring innovative methods to bring down the costs to provide the service.”
Tennessee has faced this very challenge in recent years, with former Governor Bill Haslam (R)
vetoing a prior bill passed by both the Tennessee House and Senate in 2018 to make proton therapy coverage part of state employee insurance plans.
