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Patients Against Lymphoma

 

Advocacy > Coverage of Health Care Costs for Clinical Trials

Last update: 01/02/2008

Coverage of Routine Patient Care Costs 
when Participating in  Clinical Trials  ... MOST STATES DON'T REQUIRE IT

Background:  Routine patient care 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 

PAL's Position Statement:  

The standard of care for many cancers often provides limited benefit and significant toxicities.  Progress against all cancers clearly depends on a greater participation of patients in clinical trials.

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 (see below).

Common provisions of legislation:
  • 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:
    • An Institutional Review Board
    • National Institutes of Health (NIH)
    • U.S. Food and Drug Administration 
    • U.S. Department of Defense or Veterans Affairs
    • U.S. Department of Veterans Affairs
  • There is no clearly superior, non-investigational alternative.
  • Data provide a reasonable expectation that the treatment will be at least as effective 
    as the alternative.
State
Coverage
23 = YES
33 = No
                        Act Now:
Alabama
No
How does your state measures up?

Inform your representatives:
 

  • Click here to write to your representatives.
    Click here to write to your senators

If desired, you may copy the text that follows into your message to your representative:

==
Please pass legislation to require insurance companies to cover the cost of  routine patient care for patients receiving treatment in clinical trials. 

"Routine patient care 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." ~ ACS

Position Statement of Patients Against Lymphoma:  

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.

The standard of care for many cancers often provides limited benefit and significant toxicities.  Progress against all cancers clearly depends on a greater participation of patients in clinical trials.

Out 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 (see below).

Common provisions of legislation:

* 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:

An Institutional Review Board
National Institutes of Health (NIH)
U.S. Food and Drug Administration 
U.S. Department of Defense or Veterans Affairs
U.S. Department of Veterans Affairs

* There is no clearly superior, non-investigational alternative.

* Data provide a reasonable expectation that the treatment will be at least as effective 
as the alternative.

 



 

 

Alaska
No
Arizona
Yes
Arkansas
No
California
Yes
Colorado
No
Connecticut
Yes
Delaware
YES
Florida
No
Georgia
YES
Hawaii
No
Idaho  
No
Illinois
No
Indiana
No
Iowa
No
Kansas
No
Kentucky
No
Louisiana
YES
Maine
Yes
Maryland
Yes
Massachusetts
Yes
Michigan
YES
Minnesota
No
Mississippi
No
Missouri
YES
Montana
No
Nebraska
No
Nevada
YES
New Hampshire
YES
New Jersey
YES
New Mexico
YES
New York
No
North Carolina
YES
North Dakota
No
Ohio
YES
Oklahoma
No
Oregon
No
Pennsylvania
No
Rhode Island
YES
South Carolina
No
South Dakota
No
Tennessee
YES
Texas
No
Utah
No
Vermont
YES
Virginia
YES
Washington
No
West Virginia
YES
Wisconsin
YES
Wyoming 
No
 
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.