Michigan's leading insurance regulator has issued a directive to health plans mandating coverage for clinically validated cancer treatments, including innovative genetic and biologic therapies. This significant move comes after investigative efforts by ProPublica, a nonprofit public interest news organization, and legislative pressure, spotlighting a critical gap in treatment coverage.

The directive's issuance was propelled by the case of Forrest VanPatten, a 50-year-old father whose struggle for life-saving treatment was reported by ProPublica in November. VanPatten's insurer, Priority Health, had refused to cover his gene therapy treatment, arguing that it fell outside the scope of Michigan's mandate to cover proven cancer drugs. This decision led to a tragic outcome, with VanPatten passing away in February 2020 without receiving the necessary treatment.

Forrest VanPatten's widow, Betty, and their children expressed hope that this new directive would prevent other families from enduring similar ordeals. Betty VanPatten's emotional response underscores the potential impact of this regulatory change, bringing a sense of justice and closure to their family's tragic experience.

For over three decades, Michigan's law requiring insurers to cover cancer treatments has been in place. However, the Department of Insurance and Financial Services' recent bulletin clarifies that this includes therapies developed using newer technologies not available when the law was initially enacted. This clarification is a response to the department's previous inaction since the law's 1989 inception.

Anita Fox, the director of the Department of Insurance and Financial Services, affirmed the department's commitment to ensuring that health insurers comply with state and federal laws. Meanwhile, Priority Health, responding to the legislative outcry over the VanPatten case, stated its willingness to discuss coverage decisions with legislators and highlighted its compliance with coverage requirements.

Despite Priority Health's initial stance, there was already a substantial consensus on the efficacy of the treatment needed by VanPatten, as recognized by the National Comprehensive Cancer Network.

Notably, not all Michigan health plans are subject to this new health plan directive. Employer-funded plans, regulated federally, are exempt, though some choose to follow state mandates voluntarily.

Calls for a thorough investigation into Priority Health's actions in the VanPatten case and a review of regulatory mechanisms have been voiced by both Republican and Democratic lawmakers.

Even with the insurance department's bulletin, there is a push for legislative action to include new-generation cancer treatments unequivocally under Michigan law. Sen. Jeff Irwin (D. Ann Arbor) called Priority Health’s actions “unconscionable” and, in a written statement, wants an investigation into “why and how this family was subjected to denial, delay, and death.”