New state insurance rule improves coverage for clinical trials
A new state insurance rule improves coverage for patients taking part in clinical trials. Insurers that once balked at having to pay for the IV hookup for an experimental drug, or the doctor’s visit, now must pay those costs if they would have been covered with standard treatment.
Seattle Times health reporter
Many people wanting to participate in clinical trials have stayed away, in part, because they feared the expense.
If they signed up to get an experimental cancer drug instead of standard therapy, for example, their insurers balked at covering the IV hookup or the doctor visit — costs that would have been taken care of had the drug not been experimental.
A new state insurance rule requires insurers to cover costs in trials — except the drug itself, which is typically covered by the research funding — if the company would have paid them for standard treatment. The rule, issued by the state Office of the Insurance Commissioner, took effect late last year, said Barbara Flye from the insurance office, who spoke Tuesday along with representatives of Washington’s biomedical- and pharmaceutical-research industry at a gathering at Gilda’s Club Seattle.
The news briefing was called to emphasize the benefits of clinical research in Washington state, particularly in the Greater Seattle area, and to highlight the need for people to participate in clinical trials, which are “vitally important to the overall development of new drugs,” said Jeff Trewhitt, spokesman for the drug industry’s trade group, PhRMA, the Pharmaceutical Research and Manufacturers of America.
The move to eliminate the insurance barrier for Washington patients came after many researchers said patients from other states enrolled in trials often had better coverage than patients from this state, said Erin Dziedzic, then-director of government relations for the Washington state chapter of the American Cancer Society’s Cancer Action Network.
The regulation is similar to one that will take effect in 2014 as part of the federal Affordable Care Act.
At the Gilda’s Club event, participants said many doctors don’t know about trials, patients are nervous about being “guinea pigs,” and researchers, said Dr. Nora Disis, a cancer researcher at the University of Washington, don’t have enough grant money to advertise broadly for volunteers.
Overall, some 70 percent of all clinical trials have difficulty recruiting patients and are delayed from one to six months, said Trewhitt of PhRMA.
But it wasn’t clear whether there are fewer volunteers, more research, or other causes.
One possibility: Much research now is specifically targeted to smaller subgroups, often those with a particular genetic quirk, which means fewer patients may qualify for any one study.
Even so, research plays a big part in Washington, according to a report released Tuesday by PhRMA. For example:
• The life-sciences sector is Washington’s fifth-largest industry, with more than 400 biopharmaceutical, medical technology companies and research institutions.
• In this state, that sector has seen job growth of 12 percent since 2007 through 2011, compared to a 2 percent decline in jobs for all other industries.
• It accounts for 34,000 direct jobs and supports a total of 92,000 jobs in the state.
• Life-sciences firms produce nearly $11 billion a year in goods and services and provide $7 billion in personal income.
Carol M. Ostrom: firstname.lastname@example.org, 206-464-2249, or
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