Blue Shield Reduces Coverage for Proton Beam Cancer Treatment

This week, Blue Shield of California announced that it will reduce coverage of a type of cancer treatment called proton beam therapy, the Los Angeles Times reports.

Details of Proton Beam Therapy

The therapy method uses as cyclotron to speed protons up to nearly the speed of light. The protons then form a beam about the width of a pencil that can target cancer cells with greater precision than traditional radiation treatments.

According to the Times, such accuracy can be especially helpful in cases when tumors are near a patient's eye, brain or other crucial organs.

Medicare pays more than $32,000 per proton beam treatment, compared with less than $19,000 for each traditional radiation treatment.

However, several studies have found that proton therapy does not produce better results than traditional radiation.

Details of Blue Shield's Decision

Blue Shield said that it only will pay for proton beam therapy in cases where clinical evidence supports its use, such as for certain tumors in children.

Marcus Thygeson -- a physician and chief health officer at Blue Shield -- said, "The real issue here is the growth of these expensive new technologies that drive up the cost of health care when there is no evidence of improved outcomes," adding, "It's important we set limits on their use so we can achieve a high-quality health care system but also an affordable one."

The policy change comes as Scripps Health in San Diego prepares to open a $230 million proton beam therapy center this year, the second such facility in the state.

Scripps Health's Reaction

Scripps officials said that limiting coverage for proton beam treatments fails to acknowledge that such therapies can reduce health care costs over time.

Chris Van Gorder -- CEO at Scripps Health -- said, "An insurance company looks at the short term. They are not concerned with the long-term cost impact because the patient may be with a different insurance company later" (Terhune, Los Angeles Times, 8/28).