Medicare coverage of cancer trials proposed
Medicare coverage of cancer trials proposed
Plan recycles $750 million of tobacco settlement
It's a Catch-22 that has plagued the medical community - and patients - for years. Americans older than 65 are 10 times more likely to get cancer than younger Americans, but they rarely participate in cutting edge cancer clinical trials because Medicare doesn't pay for treatments until they're established as standard therapies.
Currently less than 3% of Americans actually participate in cancer clinical trials. Those most likely to benefit from trials and provide crucial information in the fight against cancer are unlikely to participate in front-line research because they have to bear the medical costs themselves.
But under a proposal announced in February by Vice President Al Gore, that will be changing - at least on a trial basis. A groundbreaking initiative included in President Clinton's 1999 budget will provide coverage for cancer clinical trials to Medicare beneficiaries.
"The primary objective of this demonstration project would be to help make clinical trials for cancer more accessible to the older population, which is the population most affected by cancer," the National Institutes of Health (NIH) said in a statement.
"In addition, we would learn more about this area - for example, the actual cost of providing care through clinical trials as compared with the costs of normal, nonexperimental care - which can help guide policy making in the future."
The three-year demonstration project, administered by the Health Care Financing Administration (HCFA), will cover the patient care costs for those who participate in certain cancer clinical trials sponsored by the NIH.
The cost of the coverage will be financed by $750 million received as part of last year's financial settlement between the federal government and U.S. tobacco companies.
The proposal includes a review of the demonstration project no later than 30 months after enactment by the Secretary of the Department of Health and Human Services in consultation with the Institute of Medicine's National Cancer Policy Board. The review will consider whether to extend and/or expand the project which will result in a report to Congress.
Under the proposal, coverage would begin Oct. 1, 1998, the beginning of the 1999 fiscal year, and would cover the following:
· trials conducted by National Cancer Institute (NCI) programs that oversee and coordinate extramural clinical cancer research;
· trials conducted by Cooperative Groups programs;
· NCI-sponsored trials at NCI-designated cancer centers;
· NCI grants supporting clinical investigators;
· clinical trials for cancer conducted by other NIH institutes.
Patient care costs are those not directly linked to research, such as blood tests, X-rays and other services required in preparation for and monitoring of treatment, as well as aftercare. It would not cover the costs of experimental drugs, which are borne by the research sponsor.
Participants in the demonstration project would likely number in the thousands, the NIH estimates.
The NIH already has a similar arrangement with two other federal programs. The Department of Defense is conducting a demonstration program in which patient care costs in clinical cancer trials are covered for those enrolled in its TRICARE/CHAMPUS health care program. The Veteran's Administration provides coverage for eligible veterans to participate in various NCI-sponsored clinical trials throughout the country.
It remains to be seen whether the president's proposal will make it through the budget-wrangling process in Congress.
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