By Hazel Trice Edney
VIRGINA — The announcement that Defense Secretary Lloyd Austin is being treated for prostate cancer has hit home with millions of families across the nation. But in Virginia, the announcement is particularly relevant as the state’s legislature is gathering on the heels of an opinion by the state attorney general that said insurances should be covering a specific prostate cancer treatment that could save more lives.
Proton beam cancer therapy, administered by the Hampton University Proton Therapy Institute, was cast front and center just before Christmas as Attorney General Jason Miyares issued the opinion, which clarified that those insurance companies that cover radiation as a cancer therapy should not deny coverage for proton beam therapy when a patient meets the clinical standards in the policy for coverage, an issue that has raged in the state due to repeated insurance denials.
Miyares clarified in the three-page opinion that a section of the Virginia code that covers the topic “prohibits an insurance carrier that provides coverage for cancer therapy from denying a patient coverage for proton radiation therapy when the coverage determination is based on the carrier’s application of a higher standard of clinical evidence to such treatment than it uses for treatments it otherwise approves.”
The recent announcement from the Pentagon concerning Austin’s diagnoses did not include the type of treatment he is receiving. However, the fact that Austin is Black draws new attention to the health disparity between Black and White men with a prostate cancer diagnosis.
According to the National Cancer Institute (NCI), the risk of Black men dying from low-grade prostate cancer is “double that of men of other races” and Black men are slightly more likely than White men to be diagnosed with prostate cancer.
In Virginia, the city of Portsmouth has the highest African-American cancer death rates in the state and the city of Petersburg, Virginia, leads the nation with Black men dying from prostate cancer. Both Portsmouth and Petersburg are less than an hour from Hampton University.
Miyares pointed to the Hampton center, at a historically Black university, as being crucial to saving lives. “The Hampton University Proton Cancer Institute is a world-class academic and research institution that not only serves Virginians, but also treats people from around the world. They save precious lives. It’s essential that the prior authorization process is streamlined and patient access to proton radiation therapy is expanded and made accessible so that every patient can get the treatment that is right for them,” he wrote.
The opinion came as welcome news to families who have been repeatedly denied by insurance companies that have refused to pay for the treatment simply because it may cost more than other therapies and for reasons that many say are unexplained when their carriers provide coverage for other types of radiation treatment.
Mary Lambert of Richmond whose 52-year-old husband died of prostate cancer in 2019 after his insurance refused to pay for the proton beam therapy, applauded the attorney general’s opinion.
“I am elated to know that the state’s attorney has written a formal opinion,” she said. “No one’s family should have to go through what my husband and what our family went through. Our children were 9 and 12 when he passed.”
Ironically, the Virginia Legislature had already passed HB #1656 into law in 2017 stating that “each policy, contract or plan issued or provided by a carrier that provides coverage for cancer therapy shall not hold proton radiation therapy to a higher clinical standard of clinical evidence for decisions regarding coverage under the policy, contract, or plan than is applied for decisions regarding coverage of other types of radiation therapy treatment.”
Yet patients continue to report that the insurance companies are denying access. In some states, patients and patient families have successfully sued their insurance carriers in court to get them to cover proton therapy for their cancer.
Mary Lambert went on to stress the sad story of Congressman Donald McEachin (D-Va.), who recently died after beating his cancer, but his family highlighted that he died from the terrible side effects from other forms of treatment that are far more invasive than proton therapy.
“It’s been law for five years. So why are people still going through this? And I’m hoping that this administration can do what they’re supposed to do. I would not wish this on anyone,” Lambert said.
During the current session of the Virginia General Assembly, legislators will have a choice whether to further define and clarify clinical evidence that can be used to make determinations for proton treatment with HB #907.
The legislators can clarify the law to assure that when proton treatment is recommended by a patient’s physician or oncologist, it may be an acceptable clinical standard for coverage. This will simplify insurance coverage determinations and make them faster for patients who have no time to fight cancer and no time to fight their insurance company over coverage.
Bill Thomas, associate vice president of governmental relations at Hampton University and a national advocate for proton therapy puts it this way: “No one wants cancer. No one wants to be radiated. No one wants side effects from any form of cancer treatment. But if you are diagnosed with cancer, if you must have treatment and the doctor prescribes proton radiation therapy, shouldn’t you be allowed to follow the doctor’s orders?”
Thomas continues, “I am advocating for people all across – not only Virginia – but, the country because it is painful to see people suffer or die unnecessarily. I lost my Mom, Dad, and other family members from the horrible disease that wreaks havoc in the Black community. To help save one life from death or human suffering is worth all the fight in me.
“For an insurance company not to cover proton radiation therapy when they cover other forms is plain wrong. People are dying while companies – not medical doctors – are choosing what form of treatment they will pay for,” Thomas says. “It is just a shame that Hampton University has invested over $225 million in developing the Hampton University Proton Cancer Institute with little to no financial support from the State or local community. It is time that Virginia invests in its HBCUs and other institutions that provide life-saving modern medical treatment to the most vulnerable among us.”
