Miyares pro proton radiation treatment, by Hazel Trice Edney

1/25/2024, 6 p.m.
The announcement that Defense Secretary Lloyd Austin is being treated for prostate cancer has hit home with millions of families ...

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 examines an opinion by the state attorney general that said insurances should cover a specific prostate cancer treatment that could save more lives.

Proton beam cancer therapy, administered by the Hampton University Proton Therapy Institute, was casted 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.

In the three-page opinion, Mr. Miyares clarified that a section of the Virginia code “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 Mr. Austin’s diagnoses did not include the type of treatment he is receiving.

However, the fact that Mr. 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 leads the nation with Black men dying from prostate cancer. Both Portsmouth and Petersburg are less than an hour from Hampton University.

Mr. 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 already had passed HB #1656 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.

“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,” Ms. Lambert said.

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?”

The writer is president & CEO of Trice Edney Communications and editor-in-chief of Trice Edney News Wire.