Sen. Andre Jacque is seeking cosponsors for a bill that would require health insurers to cover certain costs related to participating in a clinical trial.
In a memo sent to other lawmakers, the De Pere Republican says the legislation aims to ensure clinical trial participants don’t face “unnecessary denial and interruption of coverage and delays in life-saving care” due to their insurer not covering related costs.
He notes these patients may need to see out-of-network specialists during clinical trials, and denial of coverage can lead to them missing out on participating and receiving potentially lifesaving treatment.
“The Clinical Trial Coverage Act would address this problem by requiring insurers to cover out-of-network routine care costs for clinical trial participants if no in-network provider is available, ensuring families have at least some peace of mind at a time of great stress and access to clinical trials without paying significant out-of-pocket costs for physician services,” Jacque wrote in the memo.
Federal law currently requires private insurers to cover “routine services” for these trials from in-network providers, the memo shows. But some patients’ networks may not include the correct providers, leaving them to pay the full price for clinical trial-related services.
The bill would bar health insurance policies from discriminating against anyone based on their participation in an approved clinical trial, according to the Legislative Reference Bureau.
And it would require insurers covered under the bill to impose the same cost-sharing requirements for a given item or service from an out-of-network provider as would apply for in-network providers, and pay the provider for the difference between the total cost and the cost-sharing amount, LRB wrote.
The legislation has the support of the American Cancer Society and the Leukemia and Lymphoma Society, the memo shows.
“An already overwhelmed family facing one of life’s most daunting challenges should be given every opportunity to participate in clinical trials that can truly make a difference, without worrying about out–of-network costs,” Jacque said. “By increasing participation and access to clinical trials, cures and effective treatments will be discovered benefiting generations of future patients.”
The cosponsorship deadline is 5 p.m. Monday.
–By Alex Moe
