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A clinical trial is a research study in which
doctors and researchers try to find ways to prevent, diagnose or treat
a certain disease. Participation in such a trial may help patients
seeking treatment and cures in the future. If you're considering
participating in such a trial, find out first how the trial will affect
your health insurance.
States mandating coverage for clinical trials
Arizona
California
Connecticut
Delaware
Georgia
Louisiana
Massachusetts
Maryland
Maine
Minnesota
Montana
North Carolina
New Hampshire
New Mexico
Nevada
New York
Rhode Island
South Dakota
Tennessee
Virginia
Vermont
Wisconsin
West Virginia
Source: Council for Affordable Health Insurance
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All the costs associated with a clinical trial are
usually covered by the organization running the research. However, some
health plans won't cover your "routine care" while you are a
participant in a trial. This routine care would include doctor visits,
X-rays, lab tests and hospital stays that you would have whether or not
you were a participant in the trial.
According to the National Cancer Institute, "Lack
of such coverage is a significant barrier to many patients who might
otherwise enroll in a trial. Lack of coverage also makes it harder for
researchers to successfully conduct trials that could improve
prevention and treatment options."
A total of 23 states have enacted laws requiring
coverage for routine care for those in clinical trials, according to
the Council for Affordable Health Insurance (CAHI). These state
mandates apply to certain group health plans offered through employers
but not individual policies that you'd purchase on your own.
CAHI estimates that mandates for clinical trial coverage add less than 1 percent to the cost of a plan.
For those on Medicare, the federal program covers
the routine costs of qualifying clinical trials, and "reasonable and
necessary items and services" (with some exceptions) used to diagnose
and treat complications arising from participation in all clinical
trials.
To help you find out whether there's a clinical
trial available in your area that relates to your particular disease or
stage of disease, the U.S. National Institutes of Health provides
current information about clinical research studies at www.ClinicalTrials.gov.
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