Hampton University Proton Cancer Institute (Hampton Proton) spearheaded a significant effort to expand equitable access to proton therapy in the state of Virginia. Recognizing the potential of proton therapy to offer advanced cancer treatment with fewer side effects, Hampton Proton led the advocacy for legislative changes that would ensure fair insurance coverage for this cutting-edge therapy. Their efforts culminated in the passing of HB #987, a bill designed to standardize coverage decisions for proton therapy, making it more accessible to patients across Virginia.
The bill amends the Virginia Code to adjust the standards for clinical evidence required by insurance providers when deciding on coverage for proton radiation therapy, a specialized form of cancer treatment. The key points of the bill include:
- Defines key terms like insurance providers and proton radiation therapy, which uses protons to treat cancer.
- Ensures insurance companies evaluate proton therapy the same way they do other radiation treatments.
- Justifies coverage if Medicare, Medicaid, or other government programs cover it, or if a doctor recommends it.
- Does not mandate insurance companies to cover proton therapy, but ensures fair evaluation if they do.
- Applies to new or renewed health insurance policies starting January 1, 2025.
Impact on Proton Therapy:
The bill supports broader access to proton therapy for cancer patients by standardizing how insurance providers assess its coverage compared to other treatments. This could potentially increase the use of proton therapy as insurers can no longer demand higher standards of proof for its effectiveness compared to other treatments. This change is likely to positively influence the proton therapy industry by potentially increasing demand and reducing barriers to access for patients needing this specialized treatment.
