ACA Mandates Insurance Coverage for Clinical Trials

By January 1, all insurers will be required to cover routine care for patients enrolled in clinical trials. (Typically any expmedical bill imageerimental care is provided at no cost to the patient.)

“This should be seen as a step forward for the U.S. oncology community,” wrote Dr. Y-Ning Wong in the ASCO Daily News from the American Society of Clinical Oncology’s meeting in Chicago. “However, patients and providers must remain vigilant about the law’s implementation.”

Currently there is a patchwork of state laws; as of January  2014, the Affordable Care Act (ACA) creates a federally required minimum that all private insurers must cover at least the usual care when patients enroll in a clinical trial.

Medicare already must cover routine care–plus costs due to medical complications associated with participating in a clinical trial–under a rule issued by President Clinton in 2000.

The one group not covered under the new federal rule will be “grandfathered” insurance plans—those plans of large employers which haven’t changed substantially since 2010 (from 30 to 66% of all large-employer plans in 2013, it’s estimated).

Fully 70% of children with cancer enroll in clinical trials, compared to about 3% of adults, and a majority of NCI-funded adult cancer trials failing to get enough participants to continue, according to a 2010 NIH report.

“Although the new law will not resolve all the reasons adults patients with cancer do no enroll in clinical trials,” wrote Dr. Wong, “It should remove one important (and fixable) barrier.”

Source: May 31 ASCO Daily News