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Monday, March 16, 2009

TMA Legislative Issue Brief: Coverage for Costs of Routine Care for Patients in Clinical Trials

When patients with a life-threatening disease or condition, such as cancer, participate in a clinical trial, health plans deny coverage for routine medical care, such as blood pressure checks or annual cholesterol and blood glucose screenings. Clinical trials are medical research conducted on patients who suffer from the illness the treatment hopes to cure. Clinical trials are the major way scientists evaluate new drugs that treat these life-threatening illnesses.

Patients who participate in a clinical trial often have other health issues. Diabetics, for example, require routine medical tests that monitor their blood sugar levels. If the patients were not participating in a clinical trial, their health plan would cover this cost. Twenty-three states have passed legislation requiring health plans to pay routine medical care costs for clinical trial participants. In 2000, Medicare also recognized the benefit and began to cover routine health care costs for Medicare patients who participate in clinical trials. However, Texas still does not require insurance companies to cover these costs. Instead, patients in clinical trials have to pay unnecessary and unwarranted out-of-pocket expenses.

What is worse is that health insurance companies pocket that portion of the premium dollar earmarked for paying routine medical care for the patient. Employers and employees pay expensive premiums to cover these costs. They should be able to use that benefit, even if the patient is participating in a clinical trial.

Medicine’s 2009 Agenda
  • Support legislation that allows patients with a life-threatening disease or condition participating in clinical trials to use their insurance coverage for routine medical care.
Medicine’s Message
  • Texas patients participating in a clinical trial should have the ability to use their health insurance premium dollars to pay for routine medical costs — especially when they are suffering from a life-threatening disease or condition.

Check out the Doctor’s Orders video to get a more complete view of TMA’s 2009 legislative agenda. You can see all of TMA’s 2009 legislative issue briefs on the TMA Web site.

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