Cost Coverage for Participating in a Clinical Trial

Insurance and Affordable Care Act Requirements

scientist working in lab

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You may be interested in participating in a cancer clinical trial but are concerned about whether or not you will have to pay out of pocket for the treatments costs. Let's explore the financial cost, if any, of being in a clinical trial, and how this may factor into your decision.

What Is a Clinical Trial?

A clinical trial is a study in which a person volunteers to undergo a new medication or new device for a particular health condition. The purpose of a clinical trial is to determine whether the medication or device is effective and safe. In order to participate in a clinical trial, a person has to meet certain requirements. Also, participation is purely voluntary, and there are laws and procedures in place to protect your rights as a volunteer, according to the American Cancer Society.

Are Clinical Trials Free?

No, clinical trials are not free. Someone does have to pay, but for the vast majority of the time, it's not the patient who is paying. A majority of clinical trials are federally or privately funded, so there is no cost to the participant.

Also, as of 2014, according to the Affordable Care Act, new health insurance plans must cover the routine cost of care for people participating in clinical trials that treat cancer and meet certain requirements. Routine care costs include medicines, tests, and doctor visits that a person would normally get for their cancer and healthcare, regardless of their participation in a clinical trial. This means that an insurer cannot stop paying coverage because a person volunteers for a clinical trial, and they cannot deny a person their right to participate in a clinical trial by limiting their coverage for tests associated with the trial. That being said, insurance companies do not have to cover the costs of the actual medicine or device being used in the trial.

There are also state laws regarding insurance coverage for routine costs of care. These laws vary state by state. You can learn more about insurance overage for participating in a clinical trial by going to the American Society for Clinical Oncology website.

Finally, it's good to know that Medicare reimburses patient care costs for its beneficiaries who participate in clinical trials designed to diagnose or treat cancer.

What Does This Mean for Me?

First, it's important to have a candid and thoughtful discussion with your doctor and loved ones before participating in a clinical trial. Remember, because it's a clinical trial, the outcome is unknown, so your expectations need to be realistic. Secondly, be as informed as you can about the clinical trial and the treatment you will be undergoing. Thirdly, if you are concerned about costs, be sure to confirm with your insurance company and cancer care team whether you will be responsible for any related costs.

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Article Sources

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  • American Cancer Society. (2014). Clinical Trials: What You Need to Know. 
  • American Cancer Society. Private insurers and the new health care law.