Blue Shield won't cover controversial, pricey cancer treatment

Blue Shield of California says it won't pay for an expensive, controversial cancer treatment, despite an influx of new treatment centers focusing on proton beam therapy.

The decision, which takes effect in October, was based on a lack of scientific evidence that the radiation treatment for prostate and other cancers is better than older, less expensive methods. Blue Shield typically pays $30,000 more for proton beam therapy than other available radiation treatments, the Los Angeles Times reported.

"The preponderance of medical evidence clearly shows that the treatment has about the same clinical outcomes as other forms of radiation, but it's a lot more expensive," Marcus Thygeson, Blue Shield's senior vice president and chief health officer, told the Wall Street Journal. "Because it's not cost effective, we're not going to cover it."

But Scripps Health, which is opening a $230-million proton beam therapy center this fall in San Diego, says insurers aren't recognizing the cancer therapy's long-term benefits. "An insurance company looks at the short term," Scripps CEO Chris Van Gorder told the LA Times. "They are not concerned with the long-term cost impact because the patient may be with a different insurance company later."

Blue Shield alleges the decision is part of its overall attempt to lower costs while providing quality care. "The real issue here is the growth of these expensive new technologies that drive up the cost of healthcare when there is no evidence of improved outcomes," Thygeson told the LA Times. "It's important we set limits on their use so we can achieve a high-quality healthcare system but also an affordable one."

With its policy change, Blue Shield becomes the third major insurer to reconsider proton beam therapy coverage. Aetna stopped covering the procedure for prostate cancer in August, and Cigna will review its proton coverage later this year. Plus, Regence Blue Cross Blue Shield, Highmark and Blue Cross Blue Shield of Kansas City all have already stopped covering the treatment, the WSJ noted.

Blue Shield will, however, pay for members' proton beam therapy if clinical evidence supports its use in specific cases.

To learn more:
- see the Los Angeles Times article
- read the Wall Street Journal article

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