If you build it, will they pay?
Plans to build a $235 million facility in New York City to treat cancer with proton-beam therapy are still proceeding—as are projects for new proton-beam centers around the country—even as some insurers balk at covering the pricier therapy for prostate cancers because of cost-versus-benefit concerns.
But the New York Proton Center project, which is being backed by a consortium of five leading hospitals in the city, has yet to finalize financing for the Manhattan building, which would use proton-based radiation instead of more traditional treatments.
And it has heard worries voiced by some would-be lenders about the danger of more insurance companies following Aetna's move in August to refuse to cover proton-beam treatment for prostate cancer, which can cost as twice as much as X-ray radiation treatment.
Aetna spokeswoman Tammy Arnold said the insurer's move to drop coverage was "because new evidence came out that showed that it wasn't much more effective than the other forms."
Blue Shield of California is dropping coverage of proton therapy for early-state prostate cancer next month for the same reason, while Cigna, another major insurer, is set to review their current policy of covering proton-beam therapy for prostate cancer in November.
Cigna currently considers proton therapy to be "clinically equivalent, but not clinically superior," to less-expensive "conventional external- beam radiation therapy," according to the company.
Insurers who do cover the treatment can pay out in excess of $200,000 to $300,000 for proton therapy, compared to $50,000 to $60,000 for the conventional treatment, according to an industry source. Medicare covers about $32,000 for proton therapy, compared to $19,000 for traditional radiation.
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"Every time there's a question in the press or the journals, there's a little ripple through the lenders, we see it all the time," said Dr. Simon Powell, chairman of the radiation oncology department at Memorial Sloan-Kettering Cancer Center, and a spokesman for the New York Proton Center consortium.
"You know what banks are like," he said. "It doesn't make much to take them twitchy."
According to Powell, lenders have dropped out of financing negotiations, but he said, "it's not crystal clear that it's a direct link" to their concerns over insurance coverage.