© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 4, 300,
February 16, 2000
© 2000 Oxford University Press
NEWS |
NJ Insurers Agree To Pay for Trials
In December, New Jersey became the first state where insurers have voluntarily agreed to cover all routine care costs for patients receiving treatment in cancer clinical trials. States including Maryland and Virginia have mandated insurers to cover cancer clinical studies, and several other states are considering similar legislation, but the New Jersey agreement is unique.
The agreement was hammered out by a joint working group of state officials, insurance representatives, clinicians, and patient advocates. All phases of trials run by the National Institutes of Health, the U.S. Food and Drug Administration, the Department of Defense, and the Department of Veterans Affairs are covered.
Funding for these clinical trials comes from a variety of sources, including pharmaceutical companies, private research institutions, and government agencies. Such funding usually covers the research and administration of the clinical trials, but not the ongoing care costs for enrolled patients.
As a result, patients have had to hope their insurance would cover these costs, or pay themselves.
The New Jersey agreement means that physician’s office fees, laboratory tests, and other costs incurred during clinical trials will be reimbursed for any of 4.8 million people covered by 10 major health insurers in the state. Paul Langevin, president of the New Jersey Association of Health Plans (NJAHP), which represents the 10 insurers, called the agreement a model that stresses "cooperation and consensus building" instead of "legislation, regulation, or litigation."
In February 1999, NJAHP agreed to pay for phase III clinical trials, but negotiations over phase I and phase II trials were more difficult. The state formed a broad-based working group to study whether insurers should pay for costs associated with early phase trials. The working group returned with the recommendation that all clinical trials should be covered under the agreement.
Among the cited reasons: clinical trials do not cost much more than standard care, and "in many cases cost less"; patients with life-threatening illnesses deserve increased choices for their care, including access to promising new therapies; and if more patients participated in clinical trials, the studies could be completed more quickly, leading to "improved care for all patients."
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