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ASCO issues guide for providers, patients on Affordable Care Act coverage
The American Society of Clinical Oncology recently released free information materials to help educate health care providers and patients with cancer about coverage requirements of the Affordable Care Act.
The Affordable Care Act allows more oncology patients to participate in clinical trials that test new methods of prevention, detection and treatment of cancer and other life-threatening conditions.
Clifford A. Hudis
“Clinical trials are the key to developing new medical knowledge that can improve outcomes for people with cancer,” ASCO president Clifford A. Hudis, MD, FACP, said in a press release. “ASCO and other groups fought long and hard for this law requiring insurers nationwide to cover the routine costs of care for individuals participating in clinical trials. Health care providers, financial counselors, and others involved in helping patients need to understand the law’s provisions so that their patients can benefit and we can make scientific progress.”
The Affordable Care Act, effective for health plans newly issued or renewed after Jan. 1, 2014, prohibits health plans or insurance issuers from:
- Denying participation of beneficiaries in clinical trials;
- Denying or limiting coverage of routine patient care costs, subject to the plan's out-of-network coverage policy; and/or
- Discriminating against the individual on the basis of participation in a trial.
The federal government has not yet issued regulations to guide implementation of the new law. Although much of the statutory language is clear, in the absence of federal guidance, payers will likely vary on the legal interpretation of each element of the provision. Therefore, understanding the provisions can help oncology patients and their health care providers seek the best available treatment options, which may include participation in a clinical trial.
Health care provider materials are available on ASCO’s Clinical Trials Coverage web page at www.ASCO.org/ClinicalTrialsCoverage.
Oncology patient materials — available on Cancer.Net — include an article explaining health insurance coverage of clinical trials at www.cancer.net/clinicaltrials and a fact sheet that provides an overview of the Affordable Care Act provision at www.cancer.net/factsheets.