Better coverage for clinical trials would give patients more choices

September 1, 2011

Commissioner of Securities and Insurance Monica J. Lindeen today announced a new advisory council to study ways to improve insurance coverage for cancer treatments. Currently, insurance companies cover routine care for patients who participate in clinical trials on a case-by-case basis, which can be confusing for patients and medical providers alike. The council will study and recommend ways to establish consistent coverage for Montana's cancer patients.

"No cancer patient should have to doubt whether their insurance will cover their treatment," said Lindeen. "Right now, there are new treatment methods in clinical trials that could help patients. But even when a doctor and patient agree that a new treatment is the best way to tackle the patient's cancer, insurance companies might still deny coverage. Montanans deserve better, and with expert recommendations from the advisory council, we will give all Montanans the clarity they need about cancer coverage."

Healthcare providers, insurance professionals, cancer survivors, and patient advocates are all represented on Lindeen's council, including Paul Burns, a cancer survivor from Bozeman.

Doctors told Burns he had five to ten years to live after they diagnosed him with follicular lymphoma, a cancer with a high likelihood of recurrence under normal treatment methods. His oncologist encouraged him to join a clinical trial for a new drug with the potential to delay relapse 25 to 30 years longer than standard chemotherapy alone.

Burns signed up for the clinical trial, but soon discovered his health insurance wouldn't cover routine chemotherapy treatments if he participated in the trial. Frustrated, Burns called each member of his insurance company's board of directors to persuade them to reverse the company's decision. Burns eventually convinced the insurance company to pay for his routine treatments, but not all Montanans get the same result.

"What really irked me is that I had to go through all that," said Burns. "It wasn't right. It wasn't fair."

Stories like Burns' convinced Montana's legislature to approve a study of insurance coverage for cancer trials. As Montana's chief insurance regulator, Lindeen is leading the study to bring Montana up to speed with more than 30 other states that have clear rules for clinical trials. Today, Lindeen formally filed her advisory council with the governor and secretary of state.

"I look forward to working with the council to see if we can help Montana cancer patients get better access to clinical trials," said Lindeen. "At the same time, these clinical trials can advance scientific knowledge and improve treatment in the future."

The council will hold its first meeting on September 28th in Bozeman and will accept public comment until it finishes its work in 2012. Lindeen will present the council's recommendations to Montana's next legislature. For more information on the study and the council's meetings, visit www.csi.mt.gov or call the Commissioner's office at 800-332-6148.