Accessing “Experimental” or “New” Care

Clinical trials provide additional options for care outside of today’s standard of care

When you enroll in a clinical trial, the trial sponsor is responsible for the services or medications directly related to the trial or that are not considered routine care for your treatment protocol. This may provide an avenue for you to access medications, testing or care that is not currently available outside of a clinical trial, which you may not have otherwise been able to afford or that would not have been covered in your plan language.

As of 2014, insurance companies can no longer deny or limit the coverage of routine patient costs for items or services in connection with approved clinical trials for the prevention, detection, or treatment of cancer or other life-threatening conditions.

Routine costs are defined as medical services that would typically be covered under your plan for patients with the same diagnosis undergoing treatment. Examples include follow-up imaging scans, lab work, etc. by in-network providers than you would have received had you not been participating in the clinical trial.

You will want to ask for a detailed listing of trial details to make an informed decision on participating, including the trial’s covered services and non-covered services so you are aware of your financial responsibilities.

More Expert Articles From PAF