Legislation sponsored by State Representative Norine Hammond that requires health insurance plans to provide coverage for proton beam therapy cancer treatment has been signed into law by the governor.
Representative Hammond has spent the past two years working on legislation to make it easier for cancer patients to receive proton beam therapy as part of their treatment plan. Hammond said that while proton beam therapy is approved by the U.S. Food and Drug Administration, insurance companies often restrict or refuse coverage for the treatment.
“Proton therapy is a very effective treatment for certain types of cancer,” Rep. Hammond said. “The legislation I introduced was for a constituent who had brain cancer. She was told that proton therapy was the option that she should take for her treatment. However, it was not an in-network expense so they paid tens of thousands of dollars out of pocket. That being said, she is doing wonderfully as a result of the treatment.”
House Bill 2799 requires that a health insurance policy provide coverage for medically necessary proton beam therapy for the treatment of cancer. The bill further provides that the policy shall not apply a higher standard of clinical evidence for the coverage of proton beam therapy than for any other form of radiation therapy treatment.
According to the Mayo Clinic, proton beam therapy uses positively charged protons that release their energy within the tumor. There is a small amount of entrance radiation, but virtually none travels beyond the tumor. Because the beams can be finely controlled, higher doses of radiation can be delivered to a tumor. Traditional X-ray treatment delivers radiation to everything in its path. That means tissue in front of and behind the tumor receives some damaging radiation.
An initiative of Northwestern Medicine, House Bill 2799 (Public Act 103-325) takes effect on January 1, 2024.