ASCO is a strong supporter of cancer clinical research and has identified insurance coverage of clinical trials as a leading policy priority. You can find information about state and federal coverage laws on ASCO.org’s ASCO in Action section. Included are resources explaining the federal health care reform law that requires private insurers to cover the routine-care costs associated with clinical trials participation, beginning in January 2014. The law is applicable to insurers in all states, including states that currently do not have coverage laws.

This new resource also chronicles policy efforts related to implementation of the new law, including a recent effort led by ASCO to bring together leading cancer organizations and top government regulators to discuss recommendations aimed at ensuring robust implementation.

“One of the most frustrating aspects of clinical research is when you learn that your patient, who is both interested in and eligible for a study, doesn’t have coverage for clinical trials,” said Yu-Ning Wong, MD, MSCE. Dr. Wong, a medical oncologist at Fox Chase Cancer Center and member of ASCO’s Cancer Research Committee, represented ASCO at the meeting with regulators.

Medicare’s coverage policy
The new ASCO in Action resource also includes information about Medicare’s coverage policy, which was passed in 2000. Although the Medicare policy has clarified coverage of clinical trials in traditional Medicare fee-for-services (FFS) coverage, a persistent challenge remains for individuals enrolled in Medicare Advantage (MA) or private managed-care plans. The Centers for Medicare and Medicaid Services (CMS) requires that these beneficiaries revert to FFS coverage if they enroll in a clinical trial. The MA plan is then required to reimburse beneficiaries for the difference in out-of-pocket cost-sharing between FFS and their MA plan. ASCO is an opponent of this policy because it serves as a financial and bureaucratic disincentive for MA enrollees who want to participate in research.

ASCO’s efforts on clinical trials coverage represent one of many initiatives the Society has undertaken to ensure that all people with cancer are given the opportunity to access cutting-edge treatments and advance the field of oncology through participation in clinical research.

Up-to-date information on the 2014 coverage requirement can be accessed on the ASCO in Action site.