Clinical trial insurance coverage for cancer patients under the Affordable Care Act

Background

Participation in cancer clinical trials has been shown to increase overall survival with minimal increase in cost, but enrollment in adult cancer clinical trials remains low. One factor limiting enrollment is lack of insurance coverage, but this barrier should be reduced under the 2010 Patient Protection and Affordable Care Act (ACA), which includes a provision requiring coverage for clinical trial participation as of 2014.

Methods

To assess the number of Kansas adults aged 19-64, newly covered with health insurance for participation in oncology clinical trials as a result of the ACA, a cross sectional design using extracted data from the 2012 American Community Survey, Public Use Microdata Sample to estimate the number of individuals covered by insurance and data from the 2014 Department of Health and Human Services Health Insurance Marketplace enrollment to estimate those newly enrolled through ACA.

Results

In 2014, there was an estimated increase of 3% (54,397; 95% CI: 44,149-64,244) for a total of 72% (1,171,041) of Kansans aged 19 to 64 with health insurance coverage for clinical trial participation.

Conclusion

Three main factors limit the effectiveness of the ACA provisions in expanding clinical trial coverage: 1) 'grandfathered' self-funded employer plans not subject to state Employee Retirement Income Security Act (ERISA) regulations, 2) Medicaid coverage limits not addressed under the ACA, 3) populations that remain uninsured. Kansas saw a negligible increase in insurance coverage as a result of the ACA thus lack of insurance coverage is likely to remain a concern for cancer patients.

Health care policy and cancer survivorship

The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on health care compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical.

Effect of state-mandated insurance coverage on accrual to community cancer clinical trials

Thirty-five U.S. states and territories have implemented policies requiring insurers to cover patient care costs in the context of cancer clinical trials; however, evidence of the effectiveness of these policies is limited. This study assesses the impact of state insurance mandates on clinical trial accrual among community-based practices participating in the NCI Community Clinical Oncology Program (CCOP), which enrolls approximately one-third of all NCI cancer trial participants. We analyzed CCOP clinical trial enrollment over 17 years in 37 states, 14 of which implemented coverage policies, using fixed effects least squares regression to estimate the effect of state policies on trial accrual among community providers, controlling for state and CCOP differences in capacity to recruit. Of 91 CCOPs active during this time, 28 were directly affected by coverage mandates. Average recruitment per CCOP between 1991 and 2007 was 95.1 participants per year (SD=55.8). CCOPs in states with a mandate recruited similar numbers of participants compared to states without a mandate. In multivariable analysis, treatment trial accrual among CCOPs in states that had implemented a coverage mandate, was not statistically different than accrual among CCOPs in states that did not implement a coverage mandate (β=2.95, p=0.681). State mandates did not appear to confer a benefit in terms of CCOP clinical trial accrual. State policies vary in strength, which may have diluted their effect on accrual. Nonetheless, policy mandates alone may not have a meaningful impact on participation in clinical trials in these states.

Effect of the accountable care act of 2010 on clinical trial insurance coverage

PURPOSE

The Affordable Care Act (ACA) of 2010 implemented dramatic changes in our health care system. The new law requires that insurers and health plans provide coverage for individuals participating in clinical trials. Currently, there are states that already have laws or agreements requiring clinical trial coverage, but there remain deficiencies that will need to be addressed to achieve compliance with the new law.

METHODS

State mandates were reviewed to determine current laws and agreements. The ACA was reviewed to outline its provisions, and these were compared with current mandates to identify deficiencies.

RESULTS

Eighteen states meet the requirements set forth by the ACA either through a state law or agreement; 33 states do not meet the requirements. Of these 33 states, 15 do not have any existing laws or agreements in place regarding clinical trials. In states that have deficient policies in place, the most common deficiency is the lack of phase I coverage. The second most common deficiency in policy is coverage of only therapeutic studies.

CONCLUSION

Most states currently do not meet the requirements of the ACA and will be required to make changes by 2014. The implications of the ACA with regard to insurance coverage of clinical trials remain unclear as implementation of the legislation unfolds. State governments can take steps to ensure insurance coverage by creating and expanding agreements with insurance companies.

The anticipated and unintended consequences of the patient protection and affordable care act on cancer research

Continued research is critical to build upon past improvements in mortality and morbidity from cancer. Provisions in the Patient Protection and Affordable Care Act (PPACA) of 2010 address health research that affect cancer research in many positive and some potentially negative ways. The impact of PPACA on cancer research must be viewed in the context of the federal economic situation and the ongoing reform of the American clinical trial system. Major components of PPACA affect cancer research including requiring insurance coverage of standard care provided as part of clinical trials, establishment and funding of the Patient Centered Outcomes Research Institute focused on comparative effectiveness research, and establishment of the Cures Acceleration Network to foster rapid translation of basic research to the bedside. This article reviews these programs, their strengths, and our concerns regardingtheir potential shortfalls and areas needed to support cancer research on which PPACA is silent.