CLINICAL TRIALS: Most Insurers Cover Cancer Trials
Attendees at last week's annual meeting of the American Society of Clinical Oncology were presented with information to the effect that health plans accept and pay for the "vast majority" of "claims submitted for patients being treated in experimental clinical trials," United Press International reports. Speaking at the Atlanta conference, Dr. Ezekiel Emanuel, chief of the department of bioethics at NIH, said, "Insurance reimbursement is frequent. More than 95% of oncologists submit insurance claims for patients participating in clinical trials. Less than 10% of those claims are denied for non-bone marrow transplant-related trials; less than 20% of claims are denied for bone-marrow transplant-related trials." The trend, Emanuel noted, is at odds with supposed "official insurance policies." He said, "Insurers have a rule that they will not pay for experimental therapies." How to explain the discrepancy? Emanuel said he thought many health plans simply pay claims because it is too expensive to "ferret out the claims associated with trials," and because they fear lawsuits and bad publicity (Susman, 5/19).
Making it Official
A raft of New Jersey insurers are "piloting" coverage of patient care costs incurred while enrolled in cancer trials. In addition, legislation is pending in Congress under which Medicare would pay for routine costs incurred during clinical trials.
Humana's Approach: Disease Management
In a bid to control cancer costs, Humana Inc. is launching a comprehensive oncology disease management program, starting in the Tampa Bay area. The move will turn over all oncology management of Humana patients to Benchmark Oncology Inc. of New Jersey by mid-2000, the Tampa Bay Business Journal reports. Humana said several management programs for other diseases "have cut its costs and resulted in better patient health." Some doctors, however, are concerned that caseworkers will overrule their decisions under the rubric of care paths. Radiation oncologist Dr. Kathryn Kepes said, "My concern as a practicing physician is that I want to make sure [decisions are] not independent of the doctors. If it can nip problems in the bud, then it could be good. But you want to make sure you're not being undermined by people who want to keep the patient from you, or to keep the patient out of the hospital if they need to be there." Humana spokesperson Jim Horrar countered that "the intent of the program is not to deny patients benefits" (Shepherd, 5/17 issue).