Insurers agree to coverage for cancer patients in clinical trials

[niceville]

Insurers agree to coverage for cancer patients in clinical trials

~ Compact signed today by health plans, providers and consumer groups

Tallahassee – In a major victory for tens of thousands of Floridians with cancer diagnoses, the state’s major health insurance companies have agreed to pay for routine care for persons enrolled in clinical trials.

Senate President Jeff Atwater (R-Palm Beach) and representatives of major health insurance companies, medical centers, and cancer advocacy organizations signed a Clinical Trials Compact today, guaranteeing that Floridians participating in clinical trials will not lose their health insurance coverage.

The agreement was negotiated by Senator Don Gaetz (R-Niceville), Chairman of the Senate Health Regulation Committee.

Florida becomes the fifth state to use an agreement of this kind to ensure that cancer patients receive continued health care benefits while they are being treated with experimental drugs and other therapies. Cancer is the second leading cause of death among Floridians.

Previously, some insurers discontinued coverage of even routine care if a patient entered an investigational protocol. This discouraged many people from participating in clinical trials which could potentially cure or manage their disease or help doctors learn how to help other patients.

“Under President Atwater’s leadership, we have achieved a rare and welcome breakthrough to help cancer patients receive advanced treatment, protect the health benefits they and their employers have paid for, and promote research into the care and cure of cancer,” Gaetz said. “The good news is that the job got done without the need for legislation or mandates.”

No insurance company intends to increase premiums as a result of the compact.

The compact also helps persons receive early treatment for cancer by obliging insurers to cover preventive care and cancer screening in accordance with national standards.

Atwater and Gaetz praised the state’s insurers for coming to the table and finding common ground on a complex issue. Signers to the compact include Humana, Blue Cross and Blue Shield of Florida, AvMed Health Plans, Vista Healthplans, Aetna, CIGNA and United Healthcare. Together they cover about 90 percent of the group insurance market in the state.

The compact provides coverage for care for persons in what are termed phase II, III and IV cancer clinical trials. The trials must be approved by the National Institutes of Health, National Cancer Institute, Food and Drug Administration, Veterans Administration, Department of Defense or performed by a Florida accredited school of medicine, nursing, pharmacy or licensed children’s specialty hospital.

The routine services which will continue to be provided for these patients includes all health care covered by a patient’s insurer absent the clinical trial, services required solely for the provision of investigational drugs or services, monitoring of investigational drugs, and services for the “reasonable and necessary care” arising from clinical trials including diagnosis and treatment of drug complications.

The compact does not cover the cost of investigational drugs and therapies, themselves. Those costs are often paid for by research institutions, drug companies or privately.

President Atwater and Senator Gaetz lauded the collaborative work of health provider and consumer groups who helped negotiate the agreement and will sign as endorsers: the Leukemia and Lymphoma Society, the American Cancer Society, the Florida Medical Association, the Moffitt Cancer Center, the Statutory Teaching Hospital Council, Bio Florida and the Florida Association of Health Plans.

The Department of Management Services is also endorsing the compact. Gaetz and other legislators will sponsor a minor technical adjustment to existing law to allow state employees to benefit from the agreement.

Gaetz acknowledged the support of Representative David Rivera, Chairman of the House Appropriations Committee, who expressed an early interest in the issue and assisted with the development of the agreement.

The following are comments from several of the signers and endorsers of the compact:

“All cancer patients deserve access to the groundbreaking treatments being developed in clinical trials as they fight to defeat their disease and save their lives. Thanks to the strong leadership of Senator Don Gaetz and all of our coalition partners working in the state, we have increased that access for all Floridians.”
John Walter, President and CEO, The Leukemia & Lymphoma Society

“This effort is not focused on creating an insurance mandate, but instead on bringing all interested parties to the table to craft a voluntary agreement outside the legislative process. The result is simple — Floridians benefit not only from the increased access to new cancer clinical trials but from the resulting research that will come out of the clinical trial. This research may primarily benefit those individuals who have yet to be diagnosed with cancer.”
Dr. Jill M. Sumfest, Humana, Inc.

“The Department of Management Services Division of State Group Insurance endorses this clinical trial agreement, and we look forward to working with Sen. Gaetz on his legislative initiative to bring this change in benefits to State of Florida employees and retirees.”
Ms. Linda H. South, Secretary, Florida Department of Management Services

"The Florida Medical Association applauds Sen. Don Gaetz for championing an agreement that will benefit countless numbers of cancer patients in Florida. None of this would have happened without the senator's leadership in getting all the parties together to work out a solution. Now, patients participating in clinical trials are assured access to the basic care they need and deserve."
Mr. Tim Stapleton, FMA Executive Vice President

"First of all, BCBSF is honored to be a key contributor to this important cancer clinical trial compact. As Florida's largest insurer, we felt it was important to work closely with the state's legislators to develop sound clinical coverage positions that aim to avoid cumbersome, inappropriate and potentially costly mandates. In the end, this is collaborative step in the right direction for providing the best health care for all Floridians."
Dr. Jonathan Gavra, Vice President and Chief Medical Officer, Blue Cross Blue Shield

“I appreciate Senator Gaetz’s leadership in the creation of this common-sense insurance compact. Floridians who are stricken with cancer should not have to worry about being victimized further by having their health insurance benefits denied simply because they participate in a clinical trial. I applaud the advocacy groups and insurance companies who have come together to make sure Floridians are able to take advantage of the most advanced treatments available.”
Commissioner Kevin M. McCarty, Office of Insurance Regulation



Attached is a full text of the Clinical Trial Compact.