Patients want insurance companies to cover proton therapy

Edmond Sun

By James Coburn | March 16, 2015

A cancer-free prostate gland is something for men to never take for granted, said Gary Bridwell, a cancer survivor. A routine blood test for an insurance policy alerted Bridwell that he had prostate cancer in 2011.

Still cancer-free after four years, Bridwell wants to make sure other men are able to get the same proton therapy treatment he had without their insurance being denied.

As of Jan. 1, a handful of insurance companies removed proton therapy from their insurance coverage options, state Rep. Marian Cooksey said. However, those who were already receiving the treatment would continued to be covered, she said.

Cooksey is the author of House Bill 1515, which would prohibit health benefit plans from subjecting proton radiation therapy to a higher standard of evidence than other radiation therapy when making coverage decisions, she said.

The legislation was approved in the House by a vote of 97-0 and now goes to the Senate for consideration.

“Proton therapy went through several years of doing what they needed to and then the insurance companies took it and they were paying for it,” Cooksey said. “For some reason now, they want them to go back and take several more years of testing. So they’re trying to hold them to a higher standard than what they are with traditional radiation.

“We’ve already proved all that, but they want them to do it again and they’re calling it experimental.”

Make sure the patient does their homework and knows what treatments are available, said Bridwell, owner of Ditch Witch of Oklahoma and Arkansas.

Bridwell did not miss a day of work and was able to carry on with his regular daily routine during his treatments. His 44 treatments occurred every other day. Treatments take about one hour, he said.

He is 100-percent confident of the cancer treatment he received at ProCure Proton Therapy Center in Oklahoma City, he said.

“The only thing that my insurance company has paid for since my treatment is office calls,” Bridwell said. “I have no side effects, no issues that they’ve had to treat.”

Bridwell said the benefit to insurance companies is that the residual side-effects resulting from proton therapy are minimal.

“Proton therapy is beneficial in the treatment of a broad range of tumor types, including head and neck, brain, central nervous system, prostate, breast, lung, sarcomas, gastrointestinal and many pediatric cancers, said Dr. Gary Larson, medical director of ProCure Proton Therapy Center.

Bridwell and his wife, Mary Ellen, were determined to consider all options. They learned that proton therapy results in fewer residual effects from the treatment.

“It was the best chance for me,” Bridwell said.

Proton therapy was approved for cancer treatment by the Food and Drug Administration in 1988. It is a powerful treatment for cancer and a highly-effective alternative to X-ray radiation therapy.

Proton therapy is like a laser beam that goes to the tumor without destroying healthy tissue and organs. The patient can usually return to work and go back to their lives without any downtime.

Bridwell was diagnosed with low-risk prostate cancer, which is the most common cancer diagnosed in men. At this stage of cancer, proton therapy offers a better than 90-percent chance of cure at 10 years.

ProCure does a great job in helping the patient navigate through therapy, Bridwell said.

Protons can be controlled, depositing the greatest amount of radiation right into the tumor and then stopping, allowing patients to receive higher doses with less damage to nearby healthy tissue, Larson said. In contrast, X-rays are unstoppable, and barrel through the body, affecting every tissue in their path and continuing to deliver radiation as it leaves the body. A proton beam can deposit its cargo into a tumor and stop.

“The accuracy of proton therapy decreases the potential for secondary tumors and damage to healthy tissues and organs,” Larson said.

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