Pursuing lower costs and greater access to proton therapy

by John R. Fischer, Senior Reporter | October 03, 2022
Rad Oncology Proton Therapy
From the October 2022 issue of HealthCare Business News magazine

Expanding accessibility and affordability
As clinical trials around proton therapy continue to increase and collect more insights, coverage for indications is gradually expanding. Additionally, the American Society for Radiation Oncology (ASTRO) and the National Comprehensive Cancer Network (NCCN) have slowly incorporated more indications into their guidelines based on the growing evidence for proton therapy.

Palmer says payors utilize ASTRO and NCCN as references along with the body of scientific evidence for their coverage policies. As a result, payers are slowly increasing coverage for proton therapy for certain tumors.

"Based on our experience, successful prior authorization results for proton therapy can be achieved with effective techniques, patient specific rationales, supporting evidence, and clinical trial enrollment. Although these efforts help some patients access proton therapy, the pre-authorization process leads to unnecessary delays and creates significant burdens to providers and patients," he said.

Metz says that maintaining strong relationships with insurers, both national and local, as well as associations is important for expanding coverage, and that showing the full benefits that come with reduced toxicity, and how they contribute to better outcomes is essential.

“The data is continuing to mature. By doing that we’re going to continue to push the insurers hard,” he said. “It’s a combination of publishing data and continuing to get the education out there to patients, providers and insurers. Being out there and getting out there is the key.”

Increasing the reach and accessibility for proton therapy also hinges on the cost of the technology and infrastructure. Harari says that as building footprints and infrastructures for these centers continue to shrink, so too will costs associated with them.

“As the cost of construction decreases, the cost that a center has to put forth to bring a proton beam is less and less, and then that cost savings can be passed forward to the consumer,” he said.

Hoppe says that efforts to expand particle therapy research should extend to advanced therapies like FLASH and heavy carbon ions, as well. “Proton therapy is important for delivering FLASH therapy because proton systems can more easily deliver that ultra-high dose rate of radiation compared to photon accelerators. It won’t be prime-time anytime soon, but certainly having cyclotron-based proton therapy makes FLASH a much easier thing to deliver.”

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