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 Medicare 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. http://www.cancer.gov/clinicaltrials/ctlaws-home

Overview

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

(http://www.cancer.gov/clinicaltrials/understanding/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 costs include:

• Doctor visits

• Hospital stays

• Lab tests

• X-rays and scans

• These costs are often covered by health insurance.

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 purposes

• These costs are often covered by the organization sponsoring the trial.

Created 7/18/2009 Howard Hansen