The answer is not simple,
but often the news is favorable. It turns out that it matters where you live
and how old you are. In general,
clinical trials that test treatments for cancer provide the new investigational
drug free of charge and also cover those procedures that are being done solely
for research purposes. Those things that routinely happen in the course of
cancer care—such as physician visits, routine lab tests, and scans—are
generally billed to the patient’s health insurance provider.
Many, but not all insurers
cover these costs. For those over the age of 65, Medicare covers these costs
for most clinical trials. The majority of states have passed laws requiring
that state-regulated health plans also cover such costs and The
Patient Protection
and Affordable Care Act (PPACA) (a.k.a. healthcare
reform law) requires that all insurers cover these costs by 2014.
A recent study published in the Journal of Clinical Oncology reports
that about half of current state laws fall short of the upcoming federal
requirements. The most common
shortcomings include lack of coverage for prevention studies and phase I
studies. Learn more about these issues and see where your state stands in the article.
To put a smile on your face see Larry's latest cartoon
(c) 2012 Tom Beer and Larry Axmaker
Who pays for treating the trial's treatment's side effects should they occur?
ReplyDeleteThis is a complicated area. We have an entire chapter on this topic in the book! The short answer is that side effects are a common issue with many cancer drugs (standard and experimental) and the care required to deal with a side effect is a part of routine cancer care. In most cases these costs are billed to the patient's insurance. Medicare clearly covers these costs as do most insurers in states that require coverage for clinical trials. "Coverage" should and almost always means coverage both for giving a drug and also for dealing with whatever happens next (good or bad). Some trials do have a clause that provides for compensation from the drug manufacturer for the costs of side effects. We would recommend you ask these questions about the specific trial you are considering before signing up. The research team and the written consent form should spell that out.
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