Will
my health insurance cover this?
California has a new law that requires health plans to cover "routine
patient care costs" involved in a cancer clinical trial. It's
called SB-37
and it took effect on Jan. 1, 2002.
SB-37 covers cancer patients who participate in phase
I, II, III or IV cancer treatment trials approved by the National
Institutes of Health, the U.S. Food and Drug Administration, U.S.
Department of Defense or Department of Veterans Affairs. This includes
most cancer clinical trials.
The law gives cancer patients the freedom to think about taking
part in a cancer clinical trial without having to worry about how
they will pay for it.
What are “routine patient care
costs”?
“Routine patient care costs” are the fees for any services,
tests, devices or medications you would need whether or not you
participate in a cancer clinical trial. These include doctor visits,
hospital stays, lab tests, X-rays and other tests, and any medications
or treatments that would be covered if you were not in a trial.
These also include tests needed to see if a treatment is controlling
your cancer.
“Routine patient care costs” also include the fees
for any treatment you might need in order to prevent, diagnose or
treat another medical problem while you are in a clinical trial.
Health plans do not have to pay for anti-cancer agents that are
not yet approved by the U.S. Food and Drug Administration. But in
most cases these drugs are given to clinical trial participants
at no cost by the government agency, university medical center or
pharmaceutical company that sponsors the trial.
Health insurers also are not required to pay for items or services
that are not included in your health plan. For example, if your
health plan doesn’t include coverage for home health visits,
your insurer would not have to cover these costs.
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And, if your health
plan requires you to make copayments or pay deductibles for hospital
or doctor services, medical testing or prescriptions, you would
still have to pay those expenses.
Thanks to California’s clinical trials law, participating
in a cancer clinical trial should cost you no more than receiving
standard therapy.
Additional Resources
“California’s Cancer Clinical
Trial Law: What it Means for Patients”
California Department of Managed Health Care
California Department of Insurance
California Department of Health Services
National Patient Advocate Foundation
Medicare
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