Will insurance cover the cost of a clinical trial?
Coverage and costs will vary from person to person depending on the benefits provided by your employer, insurance company and type of policy. Some plans do not cover any care/costs while enrolled in a clinical trial because the treatment is deemed experimental. The costs associated with the clinical services provided while enrolled in a clinical trial fall into two general categories: Patient-care costs and research-care costs.
- Patient-care costs include any clinical service that the organization sponsoring the study will not cover. These services/costs are generally those that would normally be covered for treating your condition, whether you are enrolled in a clinical trial or not. These costs may not be covered by your employer/insurer, which would result in you being liable for the costs. The hospital does offer financial assistance for those costs not covered by your employer/insurer but such assistance may not offset your out-of-pocket costs.
- Research-care costs are generally those services solely done for the purpose of the clinical trial, which often would not be provided if not for participating in the trial. These costs can include tests performed to analyze the research or its results as well as the costs associated with the research doctor's time. Such costs are usually covered by the organization sponsoring the trial.
Your best course of action is to check with your employer, your insurance company and the research organization to fully understand what will or will not be covered prior to your participation in the clinical trial.
To encourage your insurance company to cover your participation in a clinical trial, read this National Cancer Institute checklist.
May 07, 2013