U.S. Proton Community Endorses Model Insurance Coverage Policy for Proton Beam Therapy

Mar 31, 2014, 10:00 ET from National Association for Proton Therapy

WASHINGTON, March 31, 2014 /PRNewswire-USNewswire/ -- The U.S. proton community, consisting of 14 operating centers across the country as well as those currently in development, today released a model insurance coverage policy for treating patients with proton beam therapy.

The policy, endorsed by the Proton Therapy Consortium, and the Particle Therapy Cooperative Group-North America (PTCOG-NA), identifies types of cancers and other diseases for which proton therapy is appropriate based on existing scientific literature.   

The new Model Policy represents the clinical perspective of leading U.S. cancer treatment centers offering proton therapy as well as several other treatment options. It updates a similar insurance coverage policy that was recently advanced by the Medicare program for patients in numerous states and for certain Blue Cross Blue Shield plan members. It is also based on over 20 years of clinical experience supported by peer-reviewed scientific literature from around the world.  

"It is our hope that by endorsing a list of clinical indications supported by the scientific literature, the insurance community will be better informed about proton beam radiation and adopt this model coverage policy as their own, using it as guide for proton therapy procedures.  We also hope our model policy serves an educational tool for the broader oncology community," said Dr. Eugen Hug, president of PTCOG-NA and Chief Medical Officer at ProCure Treatment Centers.

Commenting on the newly announced model policy, Leonard Arzt, executive director of the National Association for Proton Therapy, said: "Cancer patients should be fully informed of all treatment options and should have access to the best choice when it comes to their quality of life. And they should be given that right by their insurance providers." 

Proton therapy is a form of conformal external beam radiation treatment that delivers a precise beam to the patient's tumor site while sparing surrounding healthy tissue and cells, thus reducing side effects and increasing better post treatment outcomes.

Stuart Klein, chairperson of the Proton Therapy Consortium, said: "The proton facilities, many of which offer patients and insurers multiple treatment options, are dedicated to cancer research, a value that is embraced in the model policy. As the Medicare program looks to harmonize coverage policy, we are proposing a useful tool. "

When it comes to treating children with proton therapy, Susan Ralston, executive director and founder of the Pediatric Proton Foundation, said: "Proton Therapy is the superior treatment option for certain pediatric cancers. This model policy is an excellent guide to help large self-insured employers and health plans understand the science and clinical experience behind this vital treatment option for families fighting this dreaded disease."

About the Particle Therapy Cooperative Group-North America:

The PTCOG-NA is the North American affiliate of an international non-profit scientific society of radiation oncologists and medical physicists who are committed to the advancement of science, clinical practice, patients' outcomes and cooperative research related to particle therapy, including proton therapy. Visit www.ptcog-na.org.

About the Proton Therapy Consortium:

The Proton Therapy Consortium is a non-profit corporation whose mission is to (i) raise awareness of the therapeutic benefits of proton therapy among patients, providers, and payers through education and advocacy (ii) ensure patient choice and access to affordable, high-quality proton therapy, and (iii) encourage cooperative research and innovation to advance the appropriate and cost-effective utilization of proton therapy.  Its members are world-renowned cancer centers.

Members include:

James M. Slater M.D. Proton Treatment and Research Center at Loma Linda University Medical Center, Loma Linda, CA; Indiana University Health Proton Therapy Center, Bloomington; M.D. Anderson Cancer Center's Proton Center, Houston; University of Florida Proton Therapy Institute, Jacksonville, ProCure Proton Therapy Center, Oklahoma City: Hampton University Proton Therapy Institute, Hampton, VA; CDH Proton Center, Chicago; Roberts Proton Therapy Center at UPENN, Philadelphia; ProCure Proton Therapy Center, NJ/Metro NY; SCCA Proton Therapy, A ProCure Center, Seattle; Scripps Proton Therapy Center, San Diego; S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital, St. Louis; Provision Center for Proton Therapy, Knoxville, TN; Mayo Clinic Proton Beam Therapy Program, Rochester, MN and Phoenix, AZ; Willis-Knighton Health System, Shreveport, LA; Texas Center for Proton Therapy, Irving, TX; McLaren Proton Therapy Center, Flint, MI; Proton Therapy Center at First Coast Oncology, Jacksonville, FL; University of Maryland Proton Therapy Center, Baltimore; University of Florida Health Center, Orlando; University Hospitals Seidman Cancer Center, Cleveland, Emory Proton Therapy Center, Atlanta; and Dallas Proton Treatment Center at University of Texas Southwestern Medical Center.

The entire Model Policy is posted at: www.proton-therapy.org

SOURCE National Association for Proton Therapy