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Lindeen: Clear, consistent coverage needed
for cancer patients

Results of insurance study will make clinical trials more accessible

March 19, 2012

HELENA, Mont. – Commissioner of Securities and Insurance Monica J. Lindeen today presented a landmark definition of routine care for cancer patients that improves patients' access to cutting-edge clinical trials. Responding to calls from cancer patients who couldn't get their insurance to cover routine care during clinical trials, the 2011 legislature tasked Lindeen's office with studying ways to clarify insurance coverage during potentially life-saving treatment.

"Before, getting insurance coverage during cancer clinical trials was hit-and-miss," said Lindeen. "Doctors and patients alike rarely knew what to expect. Today, I'm proud to report the meetings I've hosted with insurance companies, medical providers, and patients have produced a clear definition that will make coverage during clinical trials more accessible to patients across the state. Our work is far from finished, and I look forward to working with stakeholders and legislators to put a long-term fix into law. But now, for the first time ever, we have a standard for clear, consistent coverage during cancer clinical trials."

Currently, insurance companies cover routine care for patients in clinical trials on a case-by-case basis, which is confusing for patients and medical providers alike. The new consensus definition of routine care will clear up confusion on what insurance companies will cover for cancer patients who undergo a clinical trial.

Rep. Kathleen Williams (D-Bozeman) sponsored the study legislation in 2011 after hearing of the problem from her constituents. The bill charged Lindeen's office with bringing together an advisory council made of medical providers, insurance experts, and patients to recommend ways to clarify insurance coverage during clinical trials. Today, Lindeen presented the council's findings and recommendations to the legislature's Children, Families, Health, and Human Services Interim Committee.

Lindeen's council asked for legislation putting the routine care definition into law to be drafted as an interim committee bill for the 2013 session. The council also recommended the draft legislation prohibit denying coverage of routine care during clinical trials. Lindeen's council will continue to work toward improving communication between insurance companies and doctors, reducing confusion and streamlining coverage decisions for patients. Lindeen's office will educate medical providers, insurance companies, and patients across the state about the consensus definition to encourage its use prior to the 2013 legislative session.

"I'll continue to work with the council to draft legislation and put this commonsense fix into law," said Lindeen. "A clear definition in the law will ensure the council's hard work will stand the test of time. More importantly, it's the only way cancer patients in Montana can count on clear, consistent access to clinical trials."

For more information, contact the Commissioner's office at (800) 332-6148 or visit the Commissioner's website at csi.mt.gov.