Every type of cancer treatment, including those being tested in clinical trials, has associated costs. But, before you allow the potential costs to affect your decision about including a clinical trial in your treatment plan, take the opportunity to learn about them. The more you know, the more prepared you will feel to make the important decisions ahead.
Patients often assume that clinical trials will be too expensive because they include experimental therapies. Frequently, this is not the case. When you receive the Informed Consent form for the trial, look it over carefully because a detailed list of the costs covered by the trial is included. Before you sign the form, address all your concerns about cost and payment. The clinical trial administrators will expect you to have questions, and they are prepared to answer them.
The costs related to clinical trials typically fall into two categories:
- Routine patient care, which applies to any type of cancer treatment including those used in clinical trials, usually involves expenses related to doctor visits, hospital stays, and some testing procedures.
- Research costs are directly related to the clinical trialsand are typically covered by the trial sponsor. They include drugs and procedures.
Contact your Insurance Provider
Review your policy and contact your insurance company. Also, verify that the costs not covered through the clinical trial will either be covered by your health insurance plan or be your responsibility.
Costs that typically are not covered by insurance include the cost of the treatment or procedure being studied in the trial and any procedure only needed to collect data for the study.
If you do not have insurance or are underinsured, assistance may be available. Ask the clinical trial administrators about patient assistance programs, and explore the resources in this guide. Many patient advocacy organizations may help offset the costs and navigate the often-confusing financial part of cancer treatment.
Look into Government Assistance
Some federal and state government programs may assist with the costs associated with a clinical trial. Start by checking into these programs:
- The Patient Protection and Affordable Care Act (ACA), a federal law that regulates health plans and insurance, covers routine clinical trial costs. Clinical trials covered under the ACA must be designed to study new ways to prevent, detect or treat cancer or other life-threatening illnesses. Check whether your insurance plan covers costs outside of your health plan’s network.
- Medicare covers portions of clinical research studies, such as trials designed to evaluate a cancer drug’s effectiveness. Medicare Part A and/or Part B may cover some, such as office visits and tests, in certain qualifying clinical research studies. Medicare Advantage plans may pay the difference in your out-of-pocket costs between it and traditional Medicare. Talk with your clinical trial administrators before proceeding to ensure you understand their recommendations, the costs and the covered expenses.
- TRICARE is the Department of Defense’s health care program. In partnership with the National Cancer Institute (NCI), the Department of Defense now covers participation in Phase I, II and III NCI-sponsored cancer clinical trials as a TRICARE benefit.
- The U.S. Department of Veterans Affairs (VA) allows eligible veterans to participate in NCI-sponsored clinical trials at VA medical centers.