Barriers in Routine Care Coverage for Cancer Clinical Trial Participants Still Exist

Despite ACA mandates requiring most private health insurers to cover routine care costs for cancer clinical trial participation, denials continue.
Despite ACA mandates requiring most private health insurers to cover routine care costs for cancer clinical trial participation, denials continue.

Greater efforts are now needed to get insurers to cover routine care costs for cancer clinical trial participation, according to a study published in the journal Cancer.1

Although the Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation, researchers at the University of Kansas Cancer Center in Fairway, Kansas, found denials appear to be continuing. These delays in coverage may affect patient participation in cancer clinical trials.

The researchers report that denials may be an ongoing issue because some insurers remain exempt from the law or for other reasons. The investigators conducted a survey of 252 members of cancer research centers and community-based institutions to investigate insurance denials. They collected a focused survey of denial details in 77 participants. Using univariate and multivariate analyses, the researchers examined associations between the receipt of denials and site characteristics.

Findings reveal that 62.7% of the initial survey respondents reported at least 1 insurance denial in 2014. The study also showed sites using a precertification process were 3.04 times more likely to experience denials. That same trend of denials was also observed at sites located in states without preexisting clinical trial coverage laws (85.1%) vs states with them (82.3%). The study showed academic centers reported denials more often (71.4%) than community sites (46.4%).

Reference

1. Mackay CB, Antonelli KR, Bruinooge SS, et al. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate. Cancer. 2017 Mar 23. doi: 10.1002/cncr.30689 [Epub ahead of print]

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