By Julia Janzen, BS, LPN, CRC
Clinical trials are the driving force behind advances made in cancer treatments, yet patient participation in clinical trials is low—often because of cost concerns. Under the Affordable Care Act, however, all insurance companies must cover the routine patient costs from an in-network provider associated with an approved clinical trial, making clinical trials a much more affordable option than before.
An approved trial is defined as a trial in any phase that is aimed at preventing, detecting, or treating a health-related or behavioral outcome. It must either be federally funded or approved, be conducted under an FDA investigational new drug application, or be exempt from the necessity of an FDA investigational new drug application. If you want to participate in an unapproved trial, your insurance may not cover it, so talk to your provider before proceeding. It’s extremely important to address payment questions and concerns before deciding whether you should participate in a clinical trial.
Before the trial begins, ask for a detailed list and clarification of what services will be covered by the trial sponsor. Also, ask about what isn’t covered but is recommended as part of follow-up and ongoing care. This will help identify some of the costs that are likely not covered by your plan.
It’s important to note that federal requirements associated with the Affordable Care Act do not apply to grandfathered health plans, and the federal law does not pre-empt any state laws that require a clinical trials policy for state-regulated plans. The federal requirements are minimums, but states may impose additional requirements.
Find available cancer clinical trials near you at www.clinicaltrials.gov.
Mid-Illinois Hematology & Oncology Associates, Ltd. participates in many clinical trials for both oncology and hematology. Please contact Julia at 309-451-2207 or julia.janzen@mihoaonline.org for clinical trial opportunities in the Bloomington/Normal area.