Insurance Coverage Lags as Cancer Science, Treatment Move Forward

Insurance coverage is lagging behind evolving cancer science, especially for rare tumors, according to KFF Health News. The case of 21-year-old Mason Henderson, diagnosed with a rare brain tumor that spread to spinal fluid, illustrates the gap. After chemotherapy failed and a three-week New York City clinical trial did not work, doctors used genetic analysis earlier this year to pursue Lynparza (olaparib) from Merck and AstraZeneca in combination with chemotherapy. His neuro-oncologists justified the off-label choice based on a biologically plausible mechanism and prior responses in similar cancers, but his insurance refused coverage, citing lack of guidelines. Henderson’s type is so uncommon that large trials are unlikely, leaving insurers to rely on FDA labels and expert guidelines that may not fit rare cancers.