For more information about insurance coverage of clinical trial costs, see this feature's main page: States That Require Health Plans to Cover Patient Care Costs in Clinical Trials.
Legislation: Senate Bill 325, Senate Bill 21
Effective: January 2002, January 1, 2012
What clinical trials are covered?
- Clinical trials for treatment, palliation (supportive care), or prevention of cancer approved by one of the following:
- National Institutes of Health (NIH)
- National Cancer Institute cooperative group or center
- U.S. Food and Drug Administration
- U.S. Department of Defense
- U.S. Department of Veterans Affairs
- Clinical trials qualified to receive Medicare coverage of its routine costs under the Medicare Clinical Trial Policy established under the 9-19-00 Medicare National Coverage Determination.
Who is required to pay?
Private insurers, including individual and group health plans.
Other key provisions:
- The coverage for routine patient care costs must be subject to the terms, conditions, restrictions, exclusions, and limitations of the contract or certificate of insurance.
- Insurer may require documentation of the likelihood of therapeutic benefit, informed consent, protocol information and test results, and/or a summary of costs involved.