Does insurance pay for clinical trials?


To participate in a clinical trial, we do discuss with patients the reasons that we would recommend a clinical trial. One of the big questions that comes up during the discussion is, "Are there financial challenges in going on a clinical trial?" and one of the big questions is whether the insurance company would pay for the clinical trial. In a clinical trial setting, there are two components to the cost, categorically speaking. There is the standard of care cost and the research cost. The research cost is the research drug itself, and additional procedures and tests that need to be done because the patient is on a clinical trial. Those are considered research costs, which typically are covered by the research study itself. Whereas the standard of care costs, such as the routine blood test to be drawn before chemotherapy, the routine visits to the doctor's office, the administration of standard chemo drugs — those are considered standard of care costs. For standard of costs, they are typically being billed to the insurance company. Most of the time, the insurance that most patients have, their policy does cover the standard of care costs while they go on a clinical study.

Wen Wee Ma, MBBS