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Patients Against Lymphoma

 

Advocacy > Coverage of Patient Care Costs for Clinical Trials

Last update: 05/27/2013

Routine patient costs in clinical trials

In any clinical trial, the patient is not expected to pay for the study drug or tests that are specific to the purpose of the trial -- such as tests, procedures, drugs, and extra doctor visits.  The expenses related to the study question are covered by the sponsors the clinical trial.

Routine patient costs are the usual costs of medical care, such as doctor visits, hospital stays, clinical laboratory tests, x-rays, etc.,  that you would receive whether or not you were participating in a clinical trial.  Some health plans don't cover these costs once you join a trial, even though studies have shown that they are not appreciably higher than costs for patients who are not enrolled in trials."
(See Cost of Clinical Trials.) ~
cancer.gov 

The Affordable Care Act - changes that take effect in 2014

"Once it does take effect the new law will offer a baseline of coverage for clinical trial participants in all 50 states and the District of Columbia and help plug some gaps in existing state-level laws and agreements. It requires, for example, coverage of routine care costs for clinical trial participants in “self-insured” plans—that is, plans typically offered and run by employers who are paying the full cost of providing the benefits—governed by the federal ERISA law, Brow said."   cancer.gov
 

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Map of States paying for cost of routine care in clinical trials: cancer.gov
Information on Coverage by State provided by Cancer.gov:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
 
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
 
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
 
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
 
Our Position Statement:  

The standard of care for many cancers often provides limited benefit and significant toxicities.  Progress against all cancers clearly depends on the patients who are willing to participate in clinical trials, which can also be the most appropriate care for patients in many clinical circumstances, such as when the disease is resistant to standard therapy, or not yet curative.

We believe that it's the moral and contractual responsibility of heath insurance providers to reimburse for "routine patient care"  whether the patient is receiving standard or certified investigational treatment for life-threatening conditions such as cancer.

Our state governments can accelerate progress against cancers - and come to the aid of the heroes that are willing to participate in clinical trials - by mandating coverage for costs related to routine care
.

As of 2007, 23 states have acted by passing legislation to address this issue .

~ Patients Against Lymphoma

Common provisions of legislation:

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Coverage of routine care associated with Phase I, II, III, and IV clinical trials for treatment
or prevention of cancer approved by one of the following:
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An Institutional Review Board
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National Institutes of Health (NIH)
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U.S. Food and Drug Administration 
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U.S. Department of Defense or Veterans Affairs
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U.S. Department of Veterans Affairs
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There is no clearly superior, non-investigational alternative.
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Data provide a reasonable expectation that the treatment will be at least as effective 
as the alternative.
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright © 2004,  All Rights Reserved.