Sep 19, 2019
Clinical Trial Coverage for Medicaid Enrollees
Nearly 20% of Americans receive their health insurance coverage through Medicaid. However, unlike Medicare and other payers, Medicaid is not federally required to cover routine care costs—such as physician visits and laboratory studies—for clinical trials.
Only 12 states require this coverage, leaving over 42 million people on Medicaid potentially without clinical trial coverage.1 Paying out-of-pocket for participation is not a viable option for many patients, particularly those from a lower income household; people with household incomes under $50,000 only participate in clinical trials at a rate of 11% to 13%.2
Earlier this year, lawmakers from both sides of the aisle introduced the CLINICAL TREATMENT Act (H.R. 913), which would address this significant barrier by guaranteeing coverage for routine care costs of clinical trial participation for Medicaid enrollees with a life-threatening condition, including cancer. The bill would help ensure that Medicaid beneficiaries with cancer have access to potentially lifesaving clinical trials and will help to improve the validity of data by reducing racial and ethnic disparities in clinical trial participation (Fig. 1).
ASCO worked closely with the bill’s cosponsors to shape the legislation and is now driving grassroots efforts to gain support from other lawmakers on Capitol Hill. For more information on the proposed legislation and ways you can show your support, visit asco.org/advocacy-policy.
Throughout the spring, ASCO submitted comments to key congressional committees working to address rising prescription drug costs in the United States. ASCO supports proposals to help ensure that generic and biologic medications are widely available and have robust competition, which may foster lower-cost alternative drug treatments, along with proposals to improve transparency around the costs, fees, and rebates associated with pharmacy benefit manager (PBM) contracts. ASCO will continue to advocate on behalf of people with cancer and their providers to ensure all Americans have access to high-quality cancer care.
Access to Clinical Trials, Cancer Treatment, and High-Quality Cancer Care
Later in September, ASCO volunteers will go to Capitol Hill for an annual Advocacy Summit. Through a series of face-to-face meetings with Members of Congress and their staffs, ASCO advocates will help lawmakers understand the current realities of the cancer care delivery system and share stories about their patients and the challenges they face in accessing cancer care. Among the many issues that will be discussed are need for robust federal funding of cancer research, the importance of policies that ensure patient access to high-quality cancer care, recommendations for supporting cancer care providers in the delivery of that care, and clinical trial coverage for Medicaid enrollees. During the Advocacy Summit, ASCO will also present its Congressional Leadership Award to recognize a Member of Congress who has advanced policies to improve cancer care for patients and survivors. In addition, ASCO will acknowledge its advocacy champions—including an ASCO Advocate of the Year—who have been exceptionally active in ASCO’s advocacy activities throughout the year.
- ASCO. Policy Brief: Guarantee Coverage of Routine Care Costs of Clinical Trials for Medicaid Patients. Available at: https://www.asco.org/advocacy-policy/asco-in-action/support-routine-care.... Accessed May 2019.
- Unger JM, Gralow JR, Albain, KS, et al. JAMA Oncol. 2016;2:137-9.
Figure data sources:
- U.S. Census. QuickFacts - United States Population estimates, July 1, 2018. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045218. Accessed May 2019.
- Duma N, Vera Aguilera J, Paludo J, et al. Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. J Oncol Pract. 2018 Jan;14(1):e1-e10.