NAPT Advocacy Report: 2024

Throughout 2024, the National Association for Proton Therapy (NAPT) continued to amplify its advocacy efforts and health policy initiatives. These efforts aligned with NAPT’s mission to increase access to proton beam therapy (PBT) and foster greater awareness of its clinical benefits among policymakers, stakeholders, and the public.

On The Hill

At the beginning of the year, NAPT staff met with key federal policymakers in Washington, D.C., to advocate for proton therapy access, addressing issues like prior authorization and veterans’ care. Discussions with bipartisan Congressional offices focused on educating leaders about the value of proton therapy and its role in advancing equitable cancer treatment.

The 2024 NAPT Excellence Awards
NAPT honored U.S. Representatives Scott Peters (CA-50) and John Rutherford (FL-5) as recipients of the 2024 Champion Awards with special ceremonies in California and Florida for their bipartisan advocacy on behalf of proton therapy. To support our member centers in hosting impactful events, NAPT has developed a VIP Visit Guide, offering practical tools to plan visits and showcase the transformative potential of proton therapy to key stakeholders and policymakers. Together, these efforts reflect our shared mission to improve cancer care for all patients.

AI
This July, NAPT staff met with key stakeholders and Congressional staff members at an event co-hosted by chairs of the Senate AI Caucus where leading healthcare companies showcased AI-enabled medical devices and technologies. These innovations promise to enhance diagnostic and treatment options, where AI can complement advanced therapies like proton therapy.

Cancer Moonshot
Cancer Moonshot was a pivotal national effort dedicated to transforming cancer care and improving patient outcomes. In alignment with this mission, NAPT engaged with Cancer Moonshot leaders to advocate for the expansion of proton therapy to improve patient outcomes. Discussions emphasized the importance of making proton therapy accessible to a broader patient population and enhancing navigation services to ensure equitable access to care. Additionally, NAPT collaborated with NASA and Fred Hutchinson Cancer Center to develop “MISSION: All Systems GO!”—a program designed to support children undergoing proton therapy by drawing parallels between their treatment journey and an astronaut’s mission, thereby reducing anxiety and improving the treatment experience. Read more about the program here.

Payment Stability

CY2025 Medicare Proposed Rules
NAPT submitted comments on the CY 2025 Medicare Physician Fee Schedule (MPFS) Proposed Rule. We remain aligned with other stakeholders and continue to model and advocate for proper reimbursement rates, ensuring the long-term viability of proton therapy as a treatment option.

Radiation Oncology Case Rate (ROCR) Act
The Radiation Oncology Case Rate (ROCR) Act, was introduced to Congress May of 2024 as a mandatory value-based payment model for radiation therapy providers treating Medicare Part B beneficiaries with certain cancers. This current ROCR model delays inclusion of proton therapy for 10 years, without provisions to ensure appropriate reimbursement when it is integrated into the payment model. The legislation was not included in an end of the year package and will most likely be reintroduced in 2025.NAPT is monitoringthis legislation closely and communicating with our Congressional champions regarding its potential impact on proton therapy and emerging technologies. NAPT aims to safeguard access to this advanced treatment for patients who could benefit from it most.

Patient Access

Local Coverage Determinations
NAPT remains committed to ensuring that proton therapy is fairly considered in coverage policies and actively engages with Medicare Administrative Contractors (MACs) to advocate for equitable access. Physician leaders presented clinical research as evidence to ensure the Contractor Advisory Committee (CAC) had the necessary information when making decisions on Local Coverage Determination (LCD) policies. By closely monitoring updates to LCDs, NAPT identifies and responds to changes that may affect our member centers.

Oregon Health Authority
In August, NAPT addressed the Oregon Health Authority’s (OHA) restrictive guidelines for proton therapy coverage and emphasized that these limitations hinder patient access to advanced cancer treatments, ultimately leading to increased disparities in care. By restricting coverage, the guidelines failed to align with the broader goals of equitable healthcare and innovation, creating barriers for patients who could greatly benefit from proton therapy’s precision and reduced side effects. As a result of physician leaders meeting with the OHA, there was a request for more information on the value of proton therapy for them to consider.

Prior Authorization

Improving Seniors’ Timely Access to Care
As a member of the Regulatory Relief Coalition (RRC), NAPT actively supported the Improving Seniors’ Timely Access to Care Act, which aims to simplify the prior authorization process for Medicare Advantage beneficiaries. While not included in the end of year package, NAPT remains engaged in these efforts to ensure that prior authorization practices do not obstruct timely patient access to proton therapy. Download a fact sheet and find other information about the Seniors’ Act here.

CY2026 Proposed Policy and Technical Changes to the Medicare Advantage Program
Key provisions of the proposed rule issued by CMS in late 2024 emphasize transparency, evidence-based decision-making, and patient safety, preventing restrictive internal policies that could limit access to medically necessary treatments, including proton therapy. The absence of clear LCDs and National Coverage Determinations (NCDs) creates ambiguity in coverage decisions, often leading to inconsistent access to care and the potential for restrictive internal policies that disadvantage patients seeking advanced treatments like proton therapy. NAPT will submit comments on the proposed rules and is committed to advocating for policies that protect patient access. This issue impacts the entire radiation oncology community, as evidenced by recent research published in the Red Journal. NAPT will collaborate with stakeholders such as ASTRO to ensure a unified effort to safeguard patient care and equitable access to advanced cancer treatments.

MedPAC Report
The Medicare Payment Advisory Commission (MedPAC) drafted two reports to Congress in 2024: one in March on Medicare payment policy and another in June on Medicare and the health care delivery system. These reports cover relevant issues like prior authorization and Medicare Advantage.

State Legislation

Virginia HB #987
Virginia made significant progress in expanding access to advanced cancer treatments with the passage of HB #987 earlier this year. This landmark legislation standardizes coverage decisions for proton therapy, ensuring greater consistency and fairness for patients across the state and aims to reduce delays and financial barriers that often hinder patients from receiving this cutting-edge treatment. The bill underscores Virginia’s commitment to improving healthcare equity and outcomes, setting a precedent for other states to follow in making life-saving therapies more accessible to those in need.

End of Year Package

On December 20, 2024, Congress passed a short-term funding bill to avert a federal government shutdown, extending FY 2025 government funding through March 14, 2025. While an earlier version of the bill included a comprehensive healthcare package, the final bill retained only essential Medicare extenders. This included telehealth waivers originally introduced during the COVID-19 Public Health Emergency, ensuring their continuation beyond their scheduled expiration.

Looking Ahead to 2025

As we look ahead to the new year, key priorities include payment stability, prior authorization, and patient access. NAPT will continue working to safeguard patient access and promote equitable policies in these evolving areas. Follow our advocacy page for further updates.