Blog Entry: October 15, 2010
An August 24th article posted by Kaiser Health News titled “Health Law Requires Continued Coverage for Patients in Clinical Trials,” shares the story of a Florida man battling a rare form of soft tissue cancer whose health plan refused coverage of routine care for him on a clinical trial. Unfortunately, this is a scenario that plays out all too often across the nation. While Medicare and some health plans currently offer coverage for routine patient care costs, many others do not. Even among states that have passed legislation mandating clinical trial coverage, the mandate is limited to plans operating exclusively within its borders. Such loopholes leave patients on their own to cover these expenses as well as the added burden of transportation, childcare and time off from work. Some insurance companies mistakenly claim that paying for clinical trials would be too costly. This is typically not the case, however. In fact, past studies have indicated that costs for participants in clinical trials are actually about the same as costs for people not enrolled in trials.
The article notes that under the new Affordable Care Act passed in March 2010 by Congress, all health insurance plans will be required to cover patient care costs by 2014. The passage of this Act raises several key issues for consideration. First, while coverage of trial participation is an important achievement and a significant advancement towards enhancing access to trials for all, this alone will not translate into higher rates of accrual. Even among states that offer mandatory coverage, impact on accruals has been mixed. Individuals who are currently offered coverage for clinical trials, as well as those who will be offered health insurance under the Act do not just need to know about coverage of trial costs; they also must be aware of the purpose of trials, the safeguards in place for participants, and have assistance available to make informed choices about participation through education by peers, their primary care providers and cancer trial staff. Without this, the rate of low trial participation among adult cancer patients is likely to remain unchanged. Second, despite the great progress this act represents, it is not universal coverage, which will still leave many uninsured. ENACCT believes that these and all patients, regardless of insurance status, should not be left behind in their ability to access cancer clinical trials as a quality treatment option. Healthcare systems should closely examine their practices regarding trials access for uninsured cancer patients and implement policies to assist such individuals who are otherwise eligible.
ENACCT offers customized, solution-oriented training programs that address cancer clinical trials education and behavior change among communities, patients and providers, as well as systems transformation for cancer care institutions, to enhance access for all eligible patients. To learn more about our services for community leaders, primary care providers and cancer research staff, please contact us at info@enacct.org