A doctor in a lab conducting research

Cancer and Clinical Trials: May 20 is Clinical Trials Day

Friday, May 20, is Clinical Trials Day! Clinical trials are critical to advancing cancer research, and they also provide opportunities for individuals diagnosed with cancer to try new treatments. However, there is a lot of misinformation about what clinical trials are, how to access them, and how to pay for them. Cutting through the red tape and finding accurate information can be difficult. For answers to these questions and more, read this blog! And for a more in-depth breakdown, see Triage Cancer’s Quick Guide to Clinical Trials.

While much of this information is tailored specifically for the cancer community, it is also applicable to anyone with a serious medical condition, and the general public.

But first, what is a clinical trial?

A clinical trial is a research study that “prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.” Practically speaking, clinical trials are research studies that find and test new treatments or procedures. Without clinical trials, we would not have the medical and scientific advances for the cancer community that we have today.

How do I find a clinical trial?

Work with your health care team to identify a clinical trial that might be a good fit for you. There are many resources available to help you find a clinical trial:

How to qualify for a clinical trial?

Just because you are eligible for a trial does not mean that you will be accepted. Some clinical trials only accept a certain number of patients. Or, you may want to participate in a trial that you are not eligible for because you have already had different cancer treatments. In that case, you can ask your doctor to request a special exception to access the trial, but if approved, your results will not be included in the research study. The Food and Drug Administration (FDA) also has an Expanded Access program that allows people access to drugs or devices that have not yet been approved by the FDA.

Insurance, Cancer, and Clinical Trials

  • It is important to talk with your health care team and your insurance company to find out what insurance coverage you have for participating in a clinical trial and what out-of-pocket costs you might expect to pay. The Patient Protection & Affordable Care Act (ACA) requires most private insurance companies to cover the routine costs of your health care when you participate in a clinical trial. Routine costs include office visits, blood tests, and imaging scans that you would receive if you were getting the standard of care. Insurance companies cannot drop your coverage or refuse to let you take part in the clinical trial.
  • Insurance companies are not required to cover the research costs that are specific to the clinical trial, such as extra blood tests or imagining scans. However, most clinical trials will cover those costs. Insurance companies are also not required to cover care that you receive from doctors or hospitals that are outside the insurance company’s network, if your plan does not normally cover out-of-network providers. Some insurance companies will cover out-of-network providers, but at a lower rate, meaning that you will have higher out-of-pocket costs when getting care from those providers.
  • Some states may have laws that offer additional protections for consumers.
  • Different rules apply for government programs such as Medicare, military, and VA plans.
  • As of 1/1/22, Medicaid covers routine patient costs associated with clinical trials. Medicaid cannot deny coverage based on the state where the clinical trial is conducted, or whether the provider is in-network for Medicaid. Visit Medicaid.gov for more information.

For the complete, printable version of this Quick Guide, visit TriageCancer.org/QuickGuide-ClinicalTrials.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

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