Society of Interventional Radiology urges UHC to update policy on radioembolization treatment
The Society of Interventional Radiology is urging UnitedHealth Group to update its coverage policy for a key radioembolization procedure that treats liver metastases.
SIR submitted comments to UnitedHealthcare Community Plan on Nov. 5, contending that payments toward transarterial radioembolization (TARE)/selective internal radiation therapy (SIRT) should extend beyond the current coverage limitations in patients with liver cancer and metastases. The minimally invasive IR procedure targets blood vessels that feed tumors; providers use a catheter to inject radioactive microspheres of Yttrium-90 (Y-90) into the vessels to kill cancerous cells while sparing healthy tissue.
UHC covers TARE for some, but not all, liver metastases. The insurer's current policy covers the procedure in patients who have liver metastases secondary to colorectal carcinoma, neuroendocrine tumors and ocular melanoma. SIR is recommending the agency extend this coverage to include select patients with chemorefractory, unresectable, liver-dominant metastatic disease from breast, pancreatic, prostate and lung primary tumors.
“Although data are limited to non-randomized studies, extensive clinical experience and published literature, including multiple meta-analyses, systematic reviews, and prospective and multicenter retrospective studies, demonstrate the effectiveness and safety of transarterial radioembolization (TARE),” SIR wrote in a letter to UnitedHealth Group’s Chief Medical Officer, Anne Boland Docimo, MD, MBA, and Executive Vice President, Margaret-Mary Wilson, MD.
SIR cited ample research supporting the efficacy of TARE in this select group of patients, noting these studies show that Y-90 radioembolization consistently provides local tumor control, improved quality of life and extended survival in patients with chemorefractory or unresectable liver-dominant metastatic disease.
“Given these findings, we urge you to consider updating your commercial coverage criteria to permit locoregional intra-arterial Y-90 radioembolization for select patients with chemorefractory, unresectable, liver-dominant metastatic disease from breast, pancreatic, prostate and lung primary tumors as a conjunctive palliative treatment to improve survival and quality of life,” SIR advised, adding that an update would “ensure equitable patient access to care regardless of plan type.”
SIR’s full letter is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.