Health insurance companies consider certain factors when deciding if they will cover the costs of clinical trials. Some of the factors in your favor may include whether:

• You live in a state that requires coverage for clinical trials. Some states have laws or special agreements that require health insurance companies to pay for routine care you receive in a clinical trial. For more information, see States That Require Health Plans to Cover Patient Care Costs in Clinical Trials.
• Language in your health insurance policy allows coverage of routine patient care in a clinical trial.
• The trial is medically necessary. This is often decided on a case-by-case basis.
• The trial is a phase III trial. A health insurance company may be willing to cover a phase III trial because the treatments have already been successful with a number of people.
• The routine care costs of the trial are about the same as the routine care costs for standard therapy.
• There is no standard therapy for your type and stage of cancer.
• The trial is sponsored by the National Institutes of Health or one of the groups it supports.

If you have Medicare

Medicare will pay for routine costs in most treatment clinical trials that are funded by federal agencies, such as the National Institutes of Health. To find out more, see the NCI booklet If You Have Cancer and Have Medicare... You Should Know About Clinical Trials. You might also find the following links helpful:

Centers for Medicare and Medicaid Services

List of NCI materials about Medicare and clinical trials coverage

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