Cancer Clinical Trials Study
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Claryfying Coverage for Routine Care During Clinical Trials

The 2013 Montana legislature recently passed legislation to clarify coverage of routine costs for patients in approved clinical trials. Senate Bill 55 was requested by the Children, Families, Health, and Human Services Interim Committee and went into effect immediately upon passage. The new law helps remove the uncertainty for doctors and patients, allowing them to focus on fighting the disease instead of worrying about routine costs.

Until recently, there was much confusion and inconsistency in the insurance coverage of routine care patients receive when they undergo a clinical trial. Researchers conducting the clinical trial pay for the new treatment, but not for routine care, which is left for insurance to pay. However, the experimental nature of trials concerned insurance companies of increasing costs and deterred them from covering routine treatment that patients would receive even if they were not in the trial. Insurers considered claims from patients in clinical trials on a case-by-case basis, leading to confusion and uncertainty for patients and doctors alike.

For some cancer patients in Montana, new and innovative treatments offered through clinical trials can be the best option to beat cancer. In addition to offering hope to patients, these trials advance the treatment of cancer with new knowledge that can benefit patients for years to come.

In 2011, the Montana legislature responded to the testimony of Montanans who had to battle with insurance companies over clinical trials by passing House Bill 615, which charged the Insurance Commissioner with studying this issue and recommending solutions. Commissioner Lindeen set up an advisory council in September 2011 to help in this process. The Council met six times, took public comment, and produced a set of findings and recommendations to the commissioner in March of 2012. Commissioner Lindeen presented a report to the Children, Families, Health and Human Services Interim Committee. Senate Bill 55 was developed in response to Commissioner Lindeen's report.

The CSI will be conducting an education campaign to providers and consumers about the new law to ensure the health care community is aware of this breakthrough for Montana cancer patients. If you have questions or would like more information contact Amanda Roccabruna Eby at aeby@mt.gov or 406.444.4613.