RD89 - Evaluation of House Bill 1405: Mandated Coverage of Intensity Modulated Radiation Therapy (IMRT) for Specified Cancer Sites


Executive Summary:
Intensity Modulated Radiation Therapy (IMRT) is a significant advance in radiation technology which allows physicians to better target cancerous tumors while simultaneously sparing surrounding tissue. Recently, several third-party payers have limited their coverage of IMRT to specific cancer sites in the human body, which led to the proposal of HB 1405. Among the sites for which IMRT is no longer covered by some insurers are breast and lung cancer. HB 1405 would mandate coverage of IMRT for these sites along with several others specified in the bill.

Whether the need for the proposed mandate outweighs the costs may be different in the short term than the long term. In the short term, the need does not appear to outweigh the costs because most insurance companies already provide coverage for the cancer sites where IMRT is used most frequently and its use is most widely accepted. However, medical experts indicate that future research may provide more conclusive evidence that IMRT is superior for cancer sites where it is now considered investigational by some insurance companies, including breast and lung cancers. In the absence of the mandate and if insurance companies do not modify their policies to reflect emerging research, the adoption of IMRT for other cancer sites may be impeded. An additional consideration is whether it is appropriate for the State to mandate a treatment as specific as IMRT. Medical technology and research will advance, which may make such a specific mandate obsolete in the future.