Attorney General Jason Miyares issued a formal opinion clarifying that in Virginia, insurance companies that cover radiation therapy for cancer may not deny coverage for proton beam therapy, also known as proton beam therapy (PBT). Aijalon Carlton “AC” Cordoza (R-Hampton) requested an opinion in which Miyares analyzes current laws.
“An insurer may not, to the extent it elects to provide coverage for cancer treatment, deny coverage for proton beam therapy based on application of a higher standard of clinical evidence for proton beam therapy than the carrier’s use of other types of radiation treatment,” Miyares said.
According to Miyares’ authoritative opinion, if carriers denied coverage based on this higher standard, they would be in violation of Virginia Code § 38.2-3407.14:1. This is a Virginia law regarding accident or illness insurance, and defines proton beam therapy as “an advanced form of radiation therapy that uses protons as an alternative means of delivering radiation.”
According to the Mayo Clinic, standard radiation therapy X-rays pass through the body and can damage and kill healthy cells, tissues and organs. In PBT, protons are accelerated in a large machine called a synchrotron and then shot into the body with greater precision. Larger doses of radiation may be possible with each treatment, Foote said.
Disparities in PBT insurance coverage were the subject of a 14-year cross-sectional study conducted by Leticia M. Nogueira and colleagues and published in JAMA Network Open in April 2022.
In the study, they found that black patients who qualified for PBT were less likely to receive treatment than white patients. They found that the more facilities offering CBT were open, the greater the racial disparities, suggesting that development and increase in cancer treatments would exacerbate racial disparities. The authors stated that this would likely not improve the situation if structural determinants of access to care were not addressed.
They concluded that PBT can achieve superior dose distribution compared with conventional external photon beam irradiation. The benefits they reported included “reducing the volume of normal tissue irradiated, and improving the compatibility and quality of the targeted area.”
The treatment is more expensive than X-ray therapy. Synchrotron machines are very large and expensive. However, the study authors said the cost may be worth it because it improves patients’ quality of life and reduces late effects associated with radiation.
Cordoza expressed hope that the Attorney General’s opinion would open up access to this procedure for more people in his district.
“This landmark opinion will increase access to life-saving proton therapy and extend the lives of many cancer patients in Hampton Roads by reducing side effects and improving quality of life during and after treatment,” Cordoza said. “The Hampton University Proton Therapy Institute does great work in this area, and I hope the Attorney General’s opinion will allow the Institute to serve more Virginians as well as address racial disparities in access to high-quality cancer treatment.”
The Inova Department of Advanced Radiation is the second facility in the commonwealth where PBT is administered.