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Learn About Clinical Trials

  • Posted: 12/03/2009

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Insurance Coverage: Colorado

For more information about insurance coverage of clinical trial costs, see this feature's main page: States That Require Health Plans to Cover Patient Care Costs in Clinical Trials.

Legislation: House Bill 09-1059

Effective: August 5, 2009

What clinical trials are covered?

Insurers are required to provide coverage for routine patient care costs in clinical trials if

  • The patient's doctor determines that the patient may benefit from enrolling in the trial and recommends participation
  • The trial is approved under the 2000 Medicare National Coverage Decision (and subsequent amendments) regarding clinical trials
  • The care is provided by a registered, licensed, or certified provider and the facility and personnel providing care are experienced and competent
  • The patient has signed a statement of consent, indicating that he or she has been informed about the procedure to be undertaken, alternative methods of treatment, and the risks associated with participating in the trial
  • The patient has a disabling, progressive, or life-threatening condition

Who is required to pay?

All individual and group health insurers, including health maintenance organizations, operating in Colorado

Other key provisions

Health insurers may exclude coverage for

  • Any part of a trial paid for by a government or commercial sponsor
  • Any drug or device paid for by its manufacturer, distributor, or provider
  • Ancillary expenses such as travel and housing that a trial participant may incur
  • Any item or service provided solely for purposes of data collection or analysis and not directly related to the patient's clinical management
  • Costs for the management of the trial
  • Any health care services specifically excluded under the patient's benefit plan

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