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Clinical Trials

For patients with chronic, long-term, or terminal illnesses, access to clinical trials can be crucial in defining and treating life-threatening illnesses, especially when experimental approaches are the only treatment available. The Report Card examines whether states require managed care plans to pay for clinical trials.

Starting in 2014, health plans will be required to cover the cost of patient participation in clinical trials. "Grandfathered" plans--those that existed before the Affordable Care Act was passed--are exempt from this requirement, but plans will lose their grandfathered status if they significantly cut benefits, increase out-of-pocket spending, or change insurance carriers.

Does the state require private insurance plans to cover the costs of participating in clinical trials for adults?

States receive a "meets policy" if they require private insurance plans to pay the routine costs associated with clinical trials for adult patients.  States receive a "weak policy" if they only require insurers to offer coverage of clinical trials as a benefit in health insurance plans, but have not required that it be a covered benefit in insurance plans.  States receive a "no policy" if they do not mandate coverage for clinical trials.

State Strength of Policy Change from 2007
Alabama No Policy Same
Alaska No Policy Same
Arizona Meets Policy Same
Arkansas No Policy Same
California Meets Policy Same
Colorado Meets Policy Better
Connecticut Meets Policy Same
Delaware Meets Policy Same
District of Columbia Meets Policy Better
Florida No Policy Same
Georgia 1 No Policy Same
Hawaii No Policy Same
Idaho No Policy Same
Illinois No Policy Same
Indiana Meets Policy Better
Iowa No Policy Same
Kansas No Policy Same
Kentucky No Policy Same
Louisiana Meets Policy Same
Maine Meets Policy Same
Maryland Meets Policy Same
Massachusetts Meets Policy Same
Michigan No Policy Same
Minnesota No Policy Same
Mississippi No Policy Same
Missouri Meets Policy Same
Montana No Policy Same
Nebraska No Policy Same
Nevada Meets Policy Same
New Hampshire Meets Policy Same
New Jersey No Policy Same
New Mexico Meets Policy Same
New York 2 No Policy Same
North Carolina Meets Policy Same
North Dakota No Policy Same
Ohio Meets Policy Better
Oklahoma No Policy Same
Oregon Meets Policy Better
Pennsylvania No Policy Same
Rhode Island Meets Policy Same
South Carolina No Policy Same
South Dakota No Policy Same
Tennessee Meets Policy Same
Texas No Policy Same
Utah No Policy Same
Vermont Meets Policy Same
Virginia Meets Policy Same
Washington No Policy Same
West Virginia Meets Policy Same
Wisconsin Meets Policy Same
Wyoming Meets Policy Better

Policy Indicator Counts
Meets Policy: 
25
Limited Policy: 
0
Weak Policy: 
0
No/Harmful Policy: 
26
Better: 
6
Same: 
45
Worse: 
0

Data Sources: 1) National Conference of State Legislatures, "Clinical Trials: What are States Doing? August 2009 Update," available at http://www.ncsl.org/Default.aspx?TabId=14331, accessed September 8, 2010; 2) Susan S. Laudicina et al, State Legislative Healthcare and Insurance Issues: 2009 Survey of Plans, (Washington, D.C.: BlueCross BlueShield Association, December 2009).

Footnotes

1 Georgia was graded incorrectly in the 2007 Report Card.  It should have received a "no policy" instead of a "meets policy." Since there is no change in the individual state law for this state, the comparison with 2007 is based on the underlying data, that is, there is no change from 2007.

2 New York was graded incorrectly in the 2007 Report Card.  It should have received a "no policy" instead of a "meets policy," since coverage for participation in a clinical trials is only covered when a plan enrollee has gone through an appeal process and clinical trial participation is recommended by an external appeal agent. Since there is no change in the individual state law for this state, the comparison with 2007 is based on the underlying data, that is, there is no change from 2007.

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