CLINICAL TRIALS: HMOs Willing to Pay — On Own Terms
The medical directors of United HealthCare and PacifiCare Health have indicated that HMOs are willing to pay for experimental cancer treatments, but "on their own terms," the Arizona Daily Star reports. The announcement comes just after last week's federal legislative proposal by Rep. Matt Salmon (R-AZ) to require HMOs and other health insurers to "cover the costs of blood tests, CAT scans and other routine care of patients enrolled in" federally funded cancer treatment trials. The main problem with that proposal from the health plans' perspective is that clinical trials often require more tests, compared to routine care, which "driv[e] up costs and divert treatment dollars from other diseases." Dr. Sam Ho, medical director for PacifiCare, argues that "legislative proposals ... add bureaucracy, and they divert extremely finite and precious resources away from health care and into the compliance and monitoring efforts that invariably follow." Currently, PacifiCare enrolls patients in clinical trials on a "case-by case" basis, but Ho indicates that the HMO would like to establish a policy that eliminates that review process. While noting that cancer clinical trials are valuable, United HealthCare National Medical Director Dr. Lee Newcomer states, "From a policy standpoint, I'd like to be able to pay for trials. But I'd also like to keep insurance affordable." Both directors are waiting for recommendations from a national committee formed two years ago to "develop a policy under which HMOs will cover cancer clinical trials." That committee is comprised of representatives from the National Institutes of Health, including the National Cancer Institute, and the American Association of Health Plans. Ho anticipates that some agreement may be reached within the next few months.
Newcomer notes that United has already made some strides in expanding coverage for experimental treatments. In December, United joined a study with the Coalition of National Cancer Cooperative Groups -- funded by the NCI -- that allowed United members to enroll in "any cooperative group study conducted at two or more cancer research centers." However, Newcomer is opposed to enrolling patients in "just any trial," even those conducted at the best research centers and funded by the NCI, charging that some early drug studies are "guinea pig trials" that are often unsafe. He asserts that those studies are "seldom reported within the scientific community," and are designed to "provide an opportunity [for researchers] to publish and ... achieve academic tenure." Many cancer researchers dispute this idea. Dr. David Alberts, director of cancer prevention and control at the Arizona Cancer Center and associate dean of research in the University of Arizona College of Medicine, asserts that "early drug studies are carefully evaluated before patients are enrolled, and just as carefully monitored afterward" (Erikson, Arizona Daily Star, 8/16).