ASCO Urges CMS to Require Medicare Advantage Coverage for Clinical Trials


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ASCO and 20 other organizations representing people impacted by serious or life-threatening diseases, specialty providers, and research professionals are urging the Centers for Medicare & Medicaid Services (CMS) to correct a long-standing inequity in Medicare coverage by requiring that Medicare Advantage plans provide coverage for clinical trials.

CMS policy currently requires individuals in Medicare Advantage plans to relinquish their Medicare Advantage coverage and revert to standard fee-for-service Medicare if they wish to participate in a clinical trial. The policy is confusing and may deter Medicare Advantage enrollees from participating in a clinical trial, according to the letter.

Medicare Advantage enrollees typically chose these plans because they involve lower costs than fee-for-service coverage and provide more comprehensive coverage. Medicare Advantage enrollees, while participating in a clinical trial under the fee-for-service reimbursement, are required to cover all deductibles, copays, and the 20% coinsurance for all charges associated with clinical trial care.

“Without the cost-saving potential of [Medicare Advantage] coverage, the current policy could not only discourage [Medicare Advantage] enrollees from choosing clinical trials but also exacerbate health care disparities,” the organizations wrote. “This issue is of particular concern to us because of our eagerness to ensure access and participation of underserved populations in clinical trials,” which is also of concern to the National Institutes of Health, the National Cancer Institute, and the Food and Drug Administration. ■

© 2014. American Society of Clinical Oncology. All rights reserved.


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