Patient Care Costs
in Clinical Trials - Insurance Coverage
Only about one-half of the states
require coverage. For U.S.A. Medicare coverage, read the
document on this. Basically, Medicare does provide coverage by paying
some of the patient care costs.
States That Require Health Plans to Cover Patient
Care Costs in Clinical Trials.
Currently there are about 26 states that have passed
legislation or instituted special agreements requiring health plans to pay
the cost of routine medical care you, as a patient, receive while
participating in a clinical trial.
The following link to cancer.gov is a good place to
start to find out more about coverage.
What are "routine patient care costs"? These are
the usual costs of medical care such as doctor visits, hospital stays,
clinical lab tests, x-rays and scans, etc., that you might receive whether
or not you were in a clinical trial. Some health plans do not cover these
costs once you join a trial in spite of studies having shown that these
costs are not appreciably higher than costs for patients who are not
enrolled in trials. Lacking this coverage erects a significant barrier to
many patients from enrolling in a trial. The reason for not covering routine
patient care costs is stated to be that being on the trial means that
everything is "experimental."
These laws and agreements do not cover the research
costs associated with the conduct of the trial, such as tests purely
performed for research purposes. In most cases, such costs would be paid for
by the group sponsoring the trial, such as the National Cancer Institute or
a pharmaceutical company.
Clinical Trials and Insurance Coverage
As you think about taking part in a clinical trial,
you will face the issue of how to cover the costs of care. Even if you have
health insurance, your plan may not cover all of the costs related to
receiving treatment in a clinical trial. This is because some health
insurance companies define clinical trials as "experimental."
Costs involved in treatment clinical trials and
who pays for them
There are two types of costs associated with a
clinical trial: patient care costs and research costs.
Patient care costs fall into two groups:
Routine care costs are those related to treating
your cancer, whether you are in a trial or receiving standard therapy. These
Extra care costs are those related to taking part in
a clinical trial. These costs might include extra tests that you need as
part of the trial, but not as part of your routine care. These costs are not
always covered by health insurance.
Research costs are those related to conducting
the trial. Examples include:
Research doctor and nurse time
Analysis of results
Clinical tests performed purely for research
These costs are often covered by the
organization sponsoring the trial.
Created 7/18/2009 Howard Hansen