Who Pays For Clinical Trials?

Ways to Fund Expensive Clinical Trials

Mar 7, 2010
Leigh VanDeWalker

Money for Clinical Trials - Flickr.com

Experimental treatments can be a ray of hope, but they are also very expensive, and not usually covered by insurance. Find out who does and does not help to pay.

Facing a terminal illness is painstaking at the least. Treatments can be painful in themselves, with many harsh side effects. The most painful side effect, however, is the despair felt when standard treatments prove ineffective. Clinical trials can offer hope, but they are investigational cancer treatment programs, and cancer treatment is never inexpensive. Paying for treatment in a clinical trial can be an obstacle in itself. Due to their experimental nature, clinical trials are not frequently covered by insurers.

Federal Assistance

There are federal programs that can help cover costs incurred for treatment in a clinical trial setting:

Medicare: Reimbursement for patient participant costs associated with clinical trials is available for Medicare beneficiaries. The focus of the trial needs to be on diagnosis or treatment in order to be reimbursed. More information can be found on Medicare's website at http://www.medicare.gov.
TRICARE: The U.S. Department of Defense's health program also reimburses for costs incurred for treatment in clinical trials. Some specifications for reimbursement are that the clinical trial must be sponsored by the National Cancer Institute, it must be a Phase II or Phase III trial, and the focus of the trial must be prevention or treatment. More information on TRICARE's reimbursement policy can be found on the National Cancer Institute websiteat http://www.cancer.gov/cancertopics/factsheet/NCI/TRICARE.
VA: The U.S. Department of Veterans' Affairs covers costs for all phases and types of National Cancer Institute sponsored clinical trials for all eligible veterans. More information on VA coverage for clinical trials, see the NCI website at http://www.cancer.gov/cancertopics/factsheet/VA-clinical-trials.

Private Insurers

Unfortunately, most private insurers do not cover costs incurred for treatment in clinical trials because they classify this type of treatment as experimental or investigational. There are, however, some circumstances where some insurers will cover some or all of the costs incurred: If the treatment is judged to be medically necessary by the health plan, if the proposed treatment was not significantly more expensive than the currently covered standard treatment, or if there is currently no other standard of treatment for the condition being studied.

Patients seeking to enter a clinical trial should be sure to find out to whom they should direct their health plan's questions in order to increase their chances of approval. For more information on insurance issues, see the NCI's site. Many states have also passed laws in regard to clinical trial coverage. For more information, see the NCI's site at http://www.cancer.gov/clinicaltrials.

Source:

National Cancer Institute Factsheet. Reviewed05/19/2006.http://www.cancer.gov/cancertopics/factsheet/Information/clinical-trials