patient and her father
Credit: Rhoda Baer
The Affordable Care Act (ACA) includes provisions that may make it easier for US cancer patients to participate in clinical trials.
But this aspect of the law has not received much attention and is not well understood, according to the American Society of Clinical Oncology (ASCO).
So the organization has created educational materials for providers and patients that explain ACA coverage as it relates to clinical trials.
“ASCO and other groups fought long and hard for this law requiring insurers nationwide to cover the routine costs of care for individuals participating in clinical trials,” said ASCO President Clifford A. Hudis, MD, FACP.
“Healthcare providers, financial counselors, and others involved in helping patients need to understand the law’s provisions so that their patients can benefit and we can make scientific progress.”
The law, which is effective for health plans newly issued or renewed after January 1, 2014, prohibits health plans or insurance issuers from:
- Denying participation of beneficiaries in clinical trials
- Denying or limiting coverage of routine patient care costs, subject to the plan’s out-of-network coverage policy
- Discriminating against the individual on the basis of participation in a trial.
The federal government has not yet issued regulations to guide implementation of the law. While much of the statutory language is clear, in the absence of federal guidance, payers will likely vary on the legal interpretation of each element of the provision.
Therefore, understanding the provisions can help patients and their healthcare providers seek the best available treatment options, which may include participation in a clinical trial.
Provider materials are available on ASCO’s Clinical Trials Coverage web page at www.ASCO.org/ClinicalTrialsCoverage.
Patient materials available on Cancer.Net include a detailed article explaining health insurance coverage of clinical trials at www.cancer.net/clinicaltrials and a fact sheet that provides an overview of the ACA provision at www.cancer.net/factsheets.
