|
Dr. Christopher Walsh measures the location where the IMRT solid compensator radiation beam will hit on patient Gloria Harbridge. Walsh operates the Mid-Rivers Cancer Center. |
RICHMOND--A legislative commission yesterday heard arguments over whether insurance companies should be forced to cover a particular radiation therapy for cancer patients, but won't make a recommendation until next month.
The therapy--known as "intensity modulated radiation therapy," or IMRT--is offered at the Mid-Rivers Cancer Center in Montross, a clinic established by Dr. Christopher Walsh. IMRT delivers radiation to a tumor in a way that's more concentrated and affects less of the surrounding healthy tissue.
Walsh says it's clearly a better method than conventional radiation for some cancers. But this past spring, health insurance companies--such as Anthem--stopped covering IMRT for breast and lung cancers, saying it wasn't proven to be more beneficial to patients than conventional radiation treatment for those cancers. Several companies, including Anthem, still approve IMRT for use on other cancers, such as those of the head and neck.
Walsh and his local legislator, Del. Rob Wittman, R-Westmoreland, believe breast and lung cancers should be covered, too. So Wittman introduced a bill in the 2006 General Assembly session to mandate that health insurance providers cover IMRT for breast and lung cancers.
The legislature routinely refers mandated coverage bills to a special commission that studies them and makes recommendations on whether the state should require insurance to cover them. Insurance providers in Virginia are currently required to cover 53 different diseases and procedures--the second-highest in the country, according to the Virginia Association of Health Plans.
The special commission met yesterday, and Walsh and about 50 supporters bused down from the Northern Neck to testify that his methods of radiation treatment are better for some patients than conventional radiation, and should be covered again--as they were before Anthem made this decision last year.
"For certain kinds of cancer, IMRT is the only life-saving option," Walsh said. "This is not experimental therapy. Many experts believe it is the new standard of care."
Walsh and Wittman said it's unfair that patients who have the thousands of dollars the therapy costs can receive it, as can patients whose health insurers still cover the procedure, but that those with Anthem cannot.
They also said it's strange that Anthem stopped covering IMRT for breast and lung cancers soon after Walsh opened his clinic--he believes he's currently the only clinic in Virginia doing the particular kind of IMRT that he does. Walsh uses a "solid compensator" technique to block the radiation from healthy tissue, rather than a segmented technique that allows radiation leaks.
Representatives from Anthem and from the Virginia Association of Health Plans said the decision to stop covering IMRT for breast and lung cancers came after Medicare stopped covering the therapy for those cancers, and after Anthem did an in-house review of all the scientific studies out there, and determined there's no proof that IMRT is a better treatment than conventional radiation for breast and lung cancers.
They'll never get such proof if they don't pay for the therapy, argued Wittman, who said it's a "self-fulfilling prophecy"--if insurance doesn't cover IMRT, fewer patients will choose IMRT and there will be less opportunity to study it.
The Anthem representative said a group of oncologists is due to present a paper this month on the benefits of IMRT, and that Anthem plans to review its policy in December.
In the meantime, the commission on mandated coverage will meet again in November, and decide whether to recommend that the state should require health insurance providers cover IMRT. That recommendation will go with the bill back to the legislature in January.
Wittman asked members of the commission to make their recommendation decision based on whether they themselves would want the IMRT therapy if they had cancer.
"This is an issue of life and death for many folks," he said.
To reach CHELYEN DAVIS:
Email: cdavis@freelancestar.com
