Clinical Trials and Insurance Coverage

mesothelioma clinical trials

General Insurance Plans

In 2010, when the Affordable Care Act (ACA) was signed into law, several changes were put into place regarding the coverage of mesothelioma clinical trials.

According to the ACA:

  • Insurance companies cannot deny a patient’s participation in clinical trials.
  • Insurance companies cannot deny or limit the coverage of routine costs to patients enrolled in an approved clinical trial.
  • Insurance companies cannot increase costs (or decrease coverage) to patients because they chose to enroll in a clinical trial.

Mesothelioma Clinical Trials Cost Coverage

Routine costs of mesothelioma clinical trials include any drugs, procedures, or services that your insurance company would normally cover, no matter if you were participating in a clinical trial. Insurance companies are not required to cover anything that is outside of these routine costs, which are often called “research costs” that are typically covered by the clinical trial’s sponsor.

Medicare (Federal Coverage)

Medicare covers the following costs for mesothelioma clinical trials:

  • Any drugs, procedures, or services conducted during the clinical trial that Medicare would normally cover if you were not participating in a clinical trial.
  • Any medical care that is needed to administer the treatment being studied (although the treatment itself may not be covered).
  • Any medical care that is related to health complications from the clinical trial. For example, the prevention and management of side effects.

Medicare does not cover any research costs associated with mesothelioma clinical trials. The clinical trial’s sponsor will most likely cover the research costs.

Medicaid (State Coverage)

Federal law does not require that states cover costs of mesothelioma clinical trials through the Medicaid program. Each state has its own laws regarding coverage of clinical trial costs. However, the majority of states cover at least routine costs. It is important to check with your state’s Medicaid program. A helpful resource is www.medicaid.gov.